Pancreatic ductal adenocarcinoma screening: New perspectives

Pezzilli, Raffaele

doi:10.3748/wjg.v18.i36.4973

Cited by 11 publications

(10 citation statements)

References 34 publications

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“…In the case of a cystic incidentaloma <2 cm in diameter, a radiologic follow-up carried out yearly is recommended; in the presence of cystic lesions between 2 and 3 cm in diameter, a follow-up twice a year is suggested; finally, in the case of the radiographic appearance of worrisome features, such as mural nodules and thickening septa, and a cystic lesion of greater than 3 cm, if the patient does not have a high operative risk, surgery seems to be a good approach [2,29] . Finally, screening relatives from families in which pancreatic cancer is familial has a significant diagnostic yield, even if the major part of the pancreatic lesions found are pre-neoplastic; this is particularly true in relatives >65 years of age, confirming prior studies which show that magnetic resonance cholangiopancreatography as an initial screening modality is safe and effective [26,30] .…”

Section: Cost-effectiveness Of Follow-upsupporting

confidence: 64%

Asymptomatic Lesions of the Pancreas: An Overview

Pezzilli

2014

Journal of Gastroenterology and Hepatology Research

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The issue of pancreatic incidentaloma is relevant in clinical practice, and the correct management of these asymptomatic lesions found incidentally at imaging techniques requires prospective studies with adequate follow-ups. The current literature on this issue was reviewed and incidentalomas, both solid and cystic, are frequently diagnosed at an advanced age and the percentage of males ranged from 14.3 to 80.7%. The percentage of incidentalomas varies from 6% to 23% of the pancreatic resections performed for any cause. The prevalence of cystic incidentalomas diagnosed with imaging techniques varies from 1.2 to 2.6%. Further injury can be identified on the basis of biochemical or endoscopic examinations. Incidentalomas are found more frequently in examinations carried out for genito-urinary symptoms, chest pain or screening tests for cancer surveillance. Up to 50% of these lesions are solid and the vast majority are malignant or precancerous. Biopsy and analysis of the CEA and amylase in the cystic fluid obtained especially with an endoscopic ultrasonography is of particular importance. Given the imperfect diagnostic information available, it is necessary to evaluate the risk and benefit of a pancreatic resection when deemed appropriate because pancreatic resection involves high morbidity, and a surgical approach should be avoided for a benign condition. Solid incidentalomas generally seem to have a better prognosis than symptomatic lesions.

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Section: Cost-effectiveness Of Follow-upsupporting

confidence: 64%

Asymptomatic Lesions of the Pancreas: An Overview

Pezzilli

2014

Journal of Gastroenterology and Hepatology Research

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“…Although the most common biomarker for PC, serum carbohydrate antigen 19-9 (CA 19-9) secreted by the exocrine pancreas cells has up to 90% specificity to symptomatic patients, low positive predictive value in asymptomatic patients, false negative results in Lewis negative phenotype, and increased false positivity in the presence of obstructive jaundice limit its usefulness for the early detection of PC [6]. Advances in the technology are of crucial importance to provide the new biomarkers sensitive and specific to PC [7,8]. Since only about 10% PC patients present diagnostic genetic mutations, studies searching for biomarkers for the early detection ought to look beyond these signature mutations.…”

Section: Introductionmentioning

confidence: 99%

Imaging heterogeneity in the mitochondrial redox state of premalignant pancreas in the pancreas-specific PTEN-null transgenic mouse model

Nioka

2013

Biomark Res

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BackgroundMetabolic alteration is one of the hallmarks of carcinogenesis. We aimed to identify certain metabolic biomarkers for the early detection of pancreatic cancer (PC) using the transgenic PTEN-null mouse model. Pancreas-specific deletion of PTEN in mouse caused progressive premalignant lesions such as highly proliferative ductal metaplasia. We imaged the mitochondrial redox state of the pancreases of the transgenic mice approximately eight months old using the redox scanner, i.e., the nicotinamide adenine dinucleotide/oxidized flavoproteins (NADH/Fp) fluorescence imager at low temperature. Two different approaches, the global averaging of the redox indices without considering tissue heterogeneity along tissue depth and the univariate analysis of multi-section data using tissue depth as a covariate were adopted for the statistical analysis of the multi-section imaging data. The standard deviations of the redox indices and the histogram analysis with Gaussian fit were used to determine the tissue heterogeneity.ResultsAll methods show consistently that the PTEN deficient pancreases (Pdx1-Cre;PTENlox/lox) were significantly more heterogeneous in their mitochondrial redox state compared to the controls (PTENlox/lox). Statistical analysis taking into account the variations of the redox state with tissue depth further shows that PTEN deletion significantly shifted the pancreatic tissue to an overall more oxidized state. Oxidization of the PTEN-null group was not seen when the imaging data were analyzed by global averaging without considering the variation of the redox indices along tissue depth, indicating the importance of taking tissue heterogeneity into account for the statistical analysis of the multi-section imaging data.ConclusionsThis study reveals a possible link between the mitochondrial redox state alteration of the pancreas and its malignant transformation and may be further developed for establishing potential metabolic biomarkers for the early diagnosis of pancreatic cancer.

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“…Regarding the primary endpoint of the study, only 1.6 % of patients had at least one relative with pancreatic adenocarcinoma while 0.5 %, had a family history of familial adenocarcinoma. Pancreatic cancer has a high mortality rate but its low incidence, together with the inability to arrive at a diagnosis using low cost imaging methods, does not seem to justify the execution of screening the general population, and it is therefore important to try to intervene first on the risk factors, such as smoking, coffee, alcohol and diet [ 17 ]. Based on the observations made in this study with respect to cases of familial pancreatic cancer, the introduction of screening at least 10 years before the age of the youngest family member affected would be recommended with the use of imaging methods, such as MRI and/or CT so that early intervention can be carried out with resection surgery.…”

Section: Discussionmentioning

confidence: 99%

Implications and issues related to familial pancreatic cancer: a cohort study of hospitalized patients

et al. 2016

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BackgroundThe surveillance of subjects at risk of pancreatic cancer is restricted to clinical research; the incidence of familial pancreatic cancer needs to be better established. Thus, we aimed to evaluate the frequency of familial pancreatic cancer in a population of hospitalized patients with pancreatic cancer.MethodsA retrospective study based on the hospital charts of patients discharged with a diagnosis of pancreatic cancer. One hundred and eighty-seven patients or their relatives were called for a phone interview.ResultsThere were 97 males (51.9 %) and 90 (48.1 %) females. The overall mean ± SD age was 67.3 ± 11.8 years; the age of males was similar to that of females (P = 0140). The mean size of the tumors found was 36.3 ± 17.4 mm (range of 5–110 mm); it was related to gender but was not related to the site of the tumor or the age of the patient. Regarding genetic diseases, three females (1.6 %) had familial adenomatous polyposis; three patients (1 male and two females) (1.6 %) had at least one relative with pancreatic cancer whereas only one 80-year old male patient (0.5 %) had two relatives affected by pancreatic cancer (the mother had died at the 65 years of age and the brother had died at 75 years of age).ConclusionsThe frequency of familial pancreatic ductal adenocarcinoma is small, but its importance, from the point of view of early diagnosis, is not negligible and patients with a risk of familial cancer merit an appropriate clinical follow-up.

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Pancreatic ductal adenocarcinoma screening: New perspectives

Cited by 11 publications

References 34 publications

Asymptomatic Lesions of the Pancreas: An Overview

Asymptomatic Lesions of the Pancreas: An Overview

Imaging heterogeneity in the mitochondrial redox state of premalignant pancreas in the pancreas-specific PTEN-null transgenic mouse model

Implications and issues related to familial pancreatic cancer: a cohort study of hospitalized patients

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