Imaging Pearls ❯ Pancreas ❯ High Risk Patients (Hereditary)
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- Background: Pancreatic adenocarcinoma (PC) is a highly lethal malignancy with a survival rate of only 12%. Surveillance is recommended for high-risk individuals (HRIs), but it is not widely adopted. To address this unmet clinical need and drive early diagnosis research, we established the Pancreatic Cancer Early Detection (PRECEDE) Consortium.
Conclusions: PRECEDE provides infrastructure support to increase access to clinical surveillance for HRIs worldwide, while aiming to drive early PC detection advancements through longitudinal standardized clinical data, imaging, and biospecimen captures. Increased cyst prevalence in HRIs with FPC suggests that FPC may infer distinct biological processes. To enable the development of PC surveillance approaches better tailored to risk category, we recommend adoption of subclassification of HRIs into FPC, PGV1/FPC1, and PGV1/FPC– risk groups by surveillance protocols.
The Pancreatic Cancer Early Detection (PRECEDE) Study is a Global Effort to Drive Early Detection: Baseline Imaging Findings in High-Risk Individuals
George Zogopoulos et al.
J Natl Compr Canc Netw. 2024 Apr;22(3):158-166 - “PRECEDE is building a large-scale research resource with depth to advance the field of early PC detection, while improving access to PC surveillance for at-risk individuals worldwide. Our interim analysis suggests that classifying HRIs into FPC, PGV1/FPC1, and PGV1/FPC– risk groups may have biologic relevance with clinical significance for tailored surveillance of HRIs. We recommend that this subclassification of HRIs be adopted by surveillance protocols moving forward.”
The Pancreatic Cancer Early Detection (PRECEDE) Study is a Global Effort to Drive Early Detection: Baseline Imaging Findings in High-Risk Individuals
George Zogopoulos et al.
J Natl Compr Canc Netw. 2024 Apr;22(3):158-166 - “IPMNs are macroscopic lesions that develop within the pancreatic ductal system . These lesions are characterized by their cystic nature, mucin secretion and are less common than PanINs. Studies on HRIs indicate that cystic lesions, particularly branch-duct (BD) type IPMN, are the most commonly diagnosed abnormalities during pancreatic cancer surveillance. This occurrence is not unusual, considering the high prevalence of IPMNs, which can reach up to 11.3–25% among the general population aged ≥ 55 years and increases with age. Additionally, there is evidence suggesting that among HRIs, the cumulative incidence of IPMNs is even higher, exceeding 46% . Like PanINs, IPMNs are recognized as precancerous lesions and only a minority progress into PDAC. The ones that do progress, advance from low-grade IPMN to PDAC in approximately 6 years. The rate of progression is associated to the location of the lesion Based on their location, IPMNs can be categorized into three groups: main duct (MD), branch duct (BD), and mixed type (MT) involving both locations. Individuals with MD and MTIPMNs have a relative or absolute indication for surgery in the presence of specific risk factors, as outlined in the European evidence-based guidelines.”
Aspects and outcomes of surveillance for individuals at high‑risk of pancreatic cancer
Aleksander M. Bogdanski et al.
Fam Cancer. 2024 Apr 15. doi: 10.1007/s10689-024-00368-1. Online ahead of print. - “Pancreatic ductal adenocarcinoma (PDAC) is a major health problem with a growing incidence. It is anticipated that it will become the second-leading cause of cancer-related deaths by 2030. PDAC has a poor prognosis with a 5-year survival rate of less than 10% . While surgical resection is the only curative treatment, 80% of PDACs are unresectable at presentation. This underscores the necessity for early detection. Nonetheless, pancreatic cancer screening of the general population is not feasible due to the relatively low incidence of this disease, with 13.3 cases per 100,000 individuals per year. Even a highly accurate test would result in many false-positively diagnosed individuals, who would be subjected to unnecessary harm including operation, excessive psychological burden following from screening, and would lead to high costs.”
Aspects and outcomes of surveillance for individuals at high‑risk of pancreatic cancer
Aleksander M. Bogdanski et al.
Fam Cancer. 2024 Apr 15. doi: 10.1007/s10689-024-00368-1. Online ahead of print. - “Interestingly, it is known that up to 10% of individuals with PDAC have an underlying genetic predisposition. The incidence of PDAC among these high-risk individuals (HRIs) is higher compared to that of the general population, making surveillance more appropriate in that subpopulation. Although data on long-term screening results are recently starting to be published, several questions persist. It remains unclear whether surveillance results in an increased resection rate of PDAC, avoids an excessive number of unnecessary surgeries and improves survival outcomes compared to no surveillance.”
Aspects and outcomes of surveillance for individuals at high‑risk of pancreatic cancer
Aleksander M. Bogdanski et al.
Fam Cancer. 2024 Apr 15. doi: 10.1007/s10689-024-00368-1. Online ahead of print. - “In 2018, Canto et al. conducted a study on a surveillance cohort of 354 individuals in the United States. The cohort mainly consisted of individuals with FPC (n = 297) and the remaining 57 individuals were carriers of a genetic PV. Notably, 41 of these individuals carried a PV in BRCA1/ BRCA2, or PALB2 genes and the entire cohort included only individuals with at least six months of follow-up. The mean age of the cohort was 56.4 years and the median follow-up was 5.6 years. During the entire follow-up period a total of 10 (2.8%) PDAC cases were identified with a resection rate of 90% and a three year survival of 85%. Considering the diagnostic yield of the surveillance program, 1 (10%) stage I PDAC, 6 HGD-IPMNs and 4 PanINs-3 were detected during surveillance. In this study, 23/354 (6.5%) individuals underwent surgery for suspected malignancy, only to find out that the lesions were benign. All PDAC cases occurred in individuals with FPC, whose age ranged from 46 to 79 years old. “
Aspects and outcomes of surveillance for individuals at high‑risk of pancreatic cancer
Aleksander M. Bogdanski et al.
Fam Cancer. 2024 Apr 15. doi: 10.1007/s10689-024-00368-1. Online ahead of print. - “Moreover, while a pancreatic cancer surveillance program captures numerous cystic lesions, the limited ability to differentiate between malignant and benign cysts still leads to the unnecessary resection of benign cysts. Genomic based biomarkers show significant promise in addressing this challenge. In a multicenter study investigating targeted next-generation sequencing using pancreatic cyst fluid, a sensitivity of 88% and a specificity of 98% were observed in detecting the presence of advanced neoplasia in these cysts. Currently, surveillance relies solely on imaging, which is suboptimal. In the future, complementing biomarkers will enhance the early detection of PDAC in HRIs.”
Aspects and outcomes of surveillance for individuals at high‑risk of pancreatic cancer
Aleksander M. Bogdanski et al.
Fam Cancer. 2024 Apr 15. doi: 10.1007/s10689-024-00368-1. Online ahead of print. - “Additionally, guidelines do not provide a recommendation regarding the age at which surveillance should be discontinued. Establishing a stopping age is necessary to maintain the effectiveness of surveillance and minimize the burden. However, as every individual ages differently, with variations in fitness and health, determining a universal cutoff age is unrealistic. Reasons to discontinue surveillance, include limited life expectancy and potential risks associated with the procedures. Elderly are more likely to die from non-cancer-related causes and would subsequently no longer benefit from early PDAC detection. Moreover, patients must meet a certain level of physical fitness to undergo procedures, otherwise early PDAC detection may not yield significant benefits, as disease treatment will become unfeasible. More research needs to be conducted in this field to offer guidance on what criteria to consider in assessing the added value of surveillance in older individuals or potentially develop a prediction model that can determine whether an individual will benefit from surveillance or not.”
Aspects and outcomes of surveillance for individuals at high‑risk of pancreatic cancer
Aleksander M. Bogdanski et al.
Fam Cancer. 2024 Apr 15. doi: 10.1007/s10689-024-00368-1. Online ahead of print.
- Background and aims: To successfully implement imaging-based pancreatic cancer (PC) surveillance, it is key to understand the timeline and morphological features of neoplastic progression. We aimed to investigate the progression to neoplasia from serial prediagnostic pancreatic imaging tests in high-risk individuals, and identify factors associated with successful early detection. Methods We retrospectively examined the development of pancreatic abnormalities in high-risk individuals who were diagnosed with PC and/or underwent pancreatic surgery in 16 international surveillance programs.
Conclusion: Nearly half of high-risk individuals developing high-grade dysplasia or PC have no prior lesions detected by imaging, yet present at an advanced stage. Progression can occur before the next scheduled annual examination. More sensitive diagnostic tools or a different management strategy for rapidly-growing cysts are needed. - Conclusion: Nearly half of high-risk individuals developing high-grade dysplasia or PC have no prior lesions detected by imaging, yet present at an advanced stage. Progression can occur before the next scheduled annual examination. More sensitive diagnostic tools or a different management strategy for rapidly-growing cysts are needed.
Timeline of development of pancreatic cancer and implications for successful early detection in high-risk individual
Overbeek KA et al
On behalf of the International Cancer of the Pancreas Screening Consortium Gastroenterology (2021), doi: https://doi.org/10.1053/j.gastro.2021.10.014. - Results: Of 2552 high-risk individuals under surveillance, 28 (1%) developed neoplastic progression to PC or high-grade dysplasia during follow-up (median 29 months after baseline, IQR 40). 46% (13/28) presented with a new lesion (median size 15 mm, range 7-57), a median of 11 months (IQR 8, range 3-17) after a prior examination, by which time 77% (10/13) had progressed beyond the pancreas. The other 54% (15/28) had neoplastic progression in a previously detected lesion (12 originally cystic, 2 indeterminate, 1 solid); 11 (73%) had PC progressed beyond the pancreas. The 12 patients with cysts had been followed for 21 months (IQR 15) and had a median growth of 5 mm/year (IQR 8). Successful early detection (as high-grade dysplasia or PC confined to the pancreas) was associated with resection of cystic lesions (versus solid or indeterminate lesions, OR 5.388, 95%CI 1.525-19.029) and small lesions (OR 0.890/mm, 95%CI 0.812-0.976).
Timeline of development of pancreatic cancer and implications for successful early detection in high-risk individual
Overbeek KA et al
On behalf of the International Cancer of the Pancreas Screening Consortium Gastroenterology (2021), doi: https://doi.org/10.1053/j.gastro.2021.10.014. - “In conclusion, in the framework of an imaging-based PC surveillance research program in high-risk individuals, almost half of the cases developed a neoplastic lesion without prior signs on imaging, and by the time of detection and/or surgical treatment, the majority had already progressed beyond an early stage (T1N0M0). Progression to advanced PC therefore can occur before the next annual surveillance examination, posing the question if in certain (selected) high-risk individuals, shorter surveillance intervals are required. The other half developed from a preceding lesion that was most often cystic, but also in this group timely identification of malignant transformation was challenging. Importantly, although progressing neoplastic cysts displayed fast growth, the presence of worrisome features could not reliably differentiate cysts with neoplastic progression from those without. The implementation of novel tools, such as improved imaging techniques and the artificial analysis of images and, most likely more promising, new and accurate biomarkers, are urgently needed to improve the outcome of PC surveillance research programs in high-risk individuals and to detect high-grade dysplasia and early cancer.”
Timeline of development of pancreatic cancer and implications for successful early detection in high-risk individual
Overbeek KA et al
Gastroenterology (2021), doi: https://doi.org/10.1053/j.gastro.2021.10.014. - Purpose: Current diagnostic and treatment modalities for pancreatic cysts (PCs) are invasive and are associated with patient morbidity. The purpose of this study is to develop and evaluate machine learning algorithms to delineate mucinous from non-mucinous PCs using non-invasive CT-based radiomics.
Conclusion: Machine learning principles can be applied to PC texture features to create a mucinous phenotype classifier. Model performance did not improve with the combined model. However, specific radiomic, radiologic, and clinical features most predictive in our models can be identified using SHAP analysis.
Machine learning principles applied to CT radiomics to predict mucinous pancreatic cysts
Adam M. Awe et al.
Abdominal Radiology https://doi.org/10.1007/s00261-021-03289-0
- “A 2015 analysis of the National Cancer Institute’s Surveillance, Epidemiology, and End Results database found that patients with stage IV pancreatic cancer were, on average, only 1.3 years older than those with stage I disease. Chromothripsis, in which multiple chromosomal rearrangements occur in a single event on 1 or 2 chromosomes, may drive the rapid progression of some pancreatic cancers. Furthermore, recent 3-dimensional histological studies suggest that early stage pancreatic cancers often invade the veins, which drain directly to the liver and result in early metastatic spread.6 These hypotheses are supported by clinical data that show at diagnosis, more than half of patients with pancreatic cancer present with metastatic disease, and only 10% of patients have localized cancer.”
Screening for Pancreatic Cancer—Is There Hope?
Anne Marie Lennon, Ralph H. Hruban, Alison P. Klein
JAMA (in press) 2019 - “How can these challenges be addressed? First, there has been progress in characterizing the curable neoplasms that give rise to advanced, incurable pancreatic cancers. All 3 precursor lesions that lead to pancreatic cancer are known and well-characterized: pancreatic intraepithelial neoplasia (PanIN), intraductal papillary mucinous neoplasms (IPMNs), and mucinous cystic neoplasms (MCNs). Although high-quality data are lacking, the majority of cancers originate from PanINs, which measure less than 5 mm in diameter and can only be seen using a microscope. Together, IMPNs and MCNs ac- count for about 15% to 30% of cancers.”
Screening for Pancreatic Cancer—Is There Hope?
Anne Marie Lennon, Ralph H. Hruban, Alison P. Klein
JAMA (in press) 2019 - “Although the prevalence of pancreatic cancer is relatively low, groups with significantly increased risk can be identified and their risk quantified. High- risk populations include individuals with IPMNs or MCNs; a strong family history of pancreatic cancer (at least 2 family members); a germline pathogenic variant in BRCA1, BRCA2, p16/ CDKN2A, PALB2, STK11, ATM, PRSS1, and the DNA mismatch re- pair genes; and older individuals with new onset diabetes mellitus. Surveillance is currently recommended for individuals who are found to have an IPMN or MCN, and the International Cancer of the Pancreas Screening Consortium has developed guidelines for screening high-risk individuals.”
Screening for Pancreatic Cancer—Is There Hope?
Anne Marie Lennon, Ralph H. Hruban, Alison P. Klein
JAMA (in press) 2019 - “Second, with current technology it is often impossible to distinguish between pancreatic precursors that harbor either early cancer or high-grade dysplasia, which pose a risk great enough to warrant surgical resection, and low-grade precursors that can be safely watched. Thus, up to 60% of patients who undergo surgical resection for a precursor lesion are found to have a lesion with a low risk of progression and not to re- quire surgery at the time. Because pancreaticoduodenectomy is associated with a mortality of about 2%, some patients who undergo surgery will have no benefit, only potential harms.”
Screening for Pancreatic Cancer—Is There Hope?
Anne Marie Lennon, Ralph H. Hruban, Alison P. Klein
JAMA (in press) 2019 - “Fourth, as we have discussed, it is important to distinguish precursor lesions with a reasonable chance of progressing to advanced cancer from those with little or no risk of progression. Recently, there has been progress. Many of the somatic mutations associated with high-grade dysplasia or early invasive cancer, such as TP53 and SMAD4, are known and can be detected in cyst fluid from IPMNs and MCNs. In a recent study of approximately 600 patients with pancreatic cysts, a tumor marker panel was used to distinguish between IPMNs with high-grade dysplasia or early invasive cancer and those with no or low malignant potential with 79% sensitivity and 96% specificity.”
Screening for Pancreatic Cancer—Is There Hope?
Anne Marie Lennon, Ralph H. Hruban, Alison P. Klein
JAMA (in press) 2019 - “Although pancreatic cancer is relatively rare, populations with a significantly increased risk can now be identified and their risk quantified.8 These higher-risk populations can be targeted for screening, greatly increasing their positive pretest probability. For example, a number of germline variants have been discovered that increase the risk of pancreatic cancer. These include variants in BRCA2, BRCA1, p16/CDKN2A, PALB2, STK11, ATM, PRSS1, and the DNA mismatch repair genes. Similarly, new-onset diabetes mellitus in an elderly person significantly increases the likelihood that the person will be diagnosed as having pancreatic cancer. An integra- tion of risk factors will likely identify subgroups with a high enough positive pretest probability that they will be the first to benefit from screening.”
Screening for Pancreatic Cancer Gets a D, But the Student Is Improving
Ralph H. Hruban, MD; Keith D. Lillemoe, MD
JAMA Surgery (in press) 2019 - “In addition, we should recognize that millions of people are already undergoing screening and they just do not know it. Millions of abdominal computed tomography and magnetic resonance imaging scans are performed every year. Many of these scans will include the pancreas, and these scans provide an opportunity for early detection of asymptomatic disease. In our experience, many of these early asymptomatic cancers are subtle, and it is easy for the average radiologist to miss these lesions if they are focused on identifying the pressing clinical need of their patient. These easily missed lesions will soon be detected automatically by novel deep learning and radiomics approaches running in the background as scans are generated.”
Screening for Pancreatic Cancer Gets a D, But the Student Is Improving
Ralph H. Hruban, MD; Keith D. Lillemoe, MD
JAMA Surgery (in press) 2019 - “Notwithstanding these grim statistics, there is hope. Several studies have shown that long-term survival can be achieved when patients are diagnosed with small early-stage cancers and treated. Extending this further, the detection and treatment of precancerous lesions that give rise to invasive pancreatic ductal adenocarcinoma can prevent some patients from ever developing invasive cancer. These precursor lesions, pancreatic intraepithelial neoplasia, intraductal papillary mucinous neoplasms, and mucinous cystic neoplasms, can now be detected and treated.”
Screening for Pancreatic Cancer Gets a D, But the Student Is Improving
Ralph H. Hruban, MD; Keith D. Lillemoe, MD
JAMA Surgery (in press) 2019 - “In addition, pancreatic cancer clinically often progresses rapidly, suggesting that the window of opportunity for early detection is very narrow. For example, Yu and colleagues estimated that the average patient with pancreatic ductal adenocarcinoma progresses from stage I to stage IV disease in less than a year and a half. Indeed, venous invasion is present in most pancreatic ductal adenocarcinomas and the veins of the pancreas drain directly into the liver. Pancreatic cancers that invade veins therefore have direct access to the liver.”
Screening for Pancreatic Cancer Gets a D, But the Student Is Improving
Ralph H. Hruban, MD; Keith D. Lillemoe, MD
JAMA Surgery (in press) 2019 - “One can easily imagine the day in which high-risk individuals will be screened using new molecular-based technologies. In parallel, all abdominal imaging will be scanned using deep learning and other approaches to identify subtle changes in the pancreas. Individuals found to have a precancer will not undergo invasive surgery but instead will receive a therapeutic vaccine that will selectively kill the precancerous lesion before it has the opportunity to progress to invasive carcinoma.”
Screening for Pancreatic Cancer Gets a D, But the Student Is Improving
Ralph H. Hruban, MD; Keith D. Lillemoe, MD
JAMA Surgery (in press) 2019 
- “The USPSTF found no evidence that screening for pancreatic cancer or treatment of screen-detected pancreatic cancer improves disease-specific morbidity or mortality,or all-cause mortality. The USPSTF found adequate evidence that the magnitude of the benefits of screening for pancreatic cancer in asymptomatic adults can be bounded as no greater than small. The USPSTF found adequate evidence that the magnitude of the harms of screening for pancreatic cancer and treatment of screen-detected pancreatic cancer can be bounded as at least moderate. The USPSTF reaffirms its previous conclusion that the potential benefits of screening for pancreatic cancer in asymptomatic adults do not outweigh the potential harms.”
US Preventive Services Task Force
JAMA. 2019;322(5):438-444. - “This recommendation is a reaffirmation of the USPSTF 2004 recommendation statement against screening for pancreatic cancer in asymptomatic adults. In 2004, the USPSTF reviewed the evidence on screening for pancreatic cancer and concluded that the harms of screening for pancreatic cancer exceed any potential benefits. For the current recommendation, the USPSTF commissioned a systematic review to look for new evidence on the benefits and harms of screening. The USPSTF found no new substantial evidence that would change its recommendation and therefore reaffirms its recommendation against screening for pancreatic cancer in asymptomatic adults.”
US Preventive Services Task Force
JAMA. 2019;322(5):438-444. - “The USPSTF found no evidence that screening for pancreatic cancer or treatment of screen-detected pancreatic cancer improves disease-specific morbidity or mortality,or all-cause mortality. The USPSTF found adequate evidence that the magnitude of the benefits of screening for pancreatic cancer in asymptomatic adults can be bounded as no greater than small. The USPSTF found adequate evidence that the magnitude of the harms of screening for pancreatic cancer and treatment of screen-detected pancreatic cancer can be bounded as at least moderate. The USPSTF reaffirms its previous conclusion that the potential benefits of screening for pancreatic cancer in asymptomatic adults do not outweigh the potential harms.”
US Preventive Services Task Force
JAMA. 2019;322(5):438-444. - “In 2019, an estimated 56 770 persons will be diagnosed with pancreatic cancer and 45 750 persons will die of the disease. About 85% to 90% of persons diagnosed with pancreatic cancer do not have known familial risk or genetic syndromes, 5% to 10% of persons have familial risk, and 3% to 5% of cases are due to inherited genetic cancer syndromes (such as Peutz-Jeghers syndrome). Familial pancreatic cancer is defined as a kindred with at least 2 affected first-degree relatives; a person’s degree of familial risk depends on the number of affected relatives.”
US Preventive Services Task Force
JAMA. 2019;322(5):438-444. - “Although its incidence is low, pancreatic cancer is the third most common cause of cancer death in the United States. Based on data from the Surveillance, Epidemiology, and End Results Program from 2009 to 2015, the overall 5-year survival rate for pancreatic cancer is 9.3%, and survival rates vary depending on the stage at which it is diagnosed. The 5-year survival rate for localized pancreatic cancer is 37.4%; when regional disease is present, the 5-year survival rate is 12.4%, and when distant metastatic disease is present, the 5-year survival rate is 2.9%.Surgical intervention at an early stage is the treatment most likely to improve chances of survival; however, most cases of pancreatic cancer are detected at an advanced stage, when surgical resection is not likely to be beneficial.”
US Preventive Services Task Force
JAMA. 2019;322(5):438-444. - CONCLUSIONS AND RECOMMENDATION
The USPSTF recommends against screening for pancreatic cancer in asymptomatic adults. (D recommendation)
US Preventive Services Task Force JAMA. 2019;322(5):438-444. - USPSTF Grades and Level of Evidence
- USPSTF Grades and Level of Evidence
- “In conclusion, pancreatic resection for screening-detected lesions in HRI was associated with reasonable morbidity, rel- atively short length of stay and low readmission rate, no 90- day mortality, and significant survival compared with the national data on sporadic pancreatic cancer.”
Surgical Outcomes After Pancreatic Resection of Screening-Detected Lesions in Individuals at High Risk for Developing Pancreatic Cancer
Marcia Irene Canto1 & Tossapol Kerdsirichairat1 & Charles J. Yeo2 & Ralph H. Hruban3 & Eun Ji Shin1 &Jose Alejandro Almario1 & Amanda Blackford4 & Madeline Ford3 & Alison P. Klein4 & Ammar A. Javed5 &Anne Marie Lennon 1 & Atif Zaheer 6 & Ihab R. Kamel 6 & Elliot K. Fishman 6 & Richard Burkhart 5 & Jin He 5 & Martin Makary 5 & Matthew J. Weiss5 & Richard D. Schulick7 & Michael G. Goggins1,3 & Christopher L. Wolfgang5
Journal of Gastrointestinal Surgery https://doi.org/10.1007/s11605-019-04 - “In conclusion, pancreatic resection for screening-detected lesions in HRI was associated with reasonable morbidity, rel- atively short length of stay and low readmission rate, no 90- day mortality, and significant survival compared with the national data on sporadic pancreatic cancer.”
Surgical Outcomes After Pancreatic Resection of Screening-Detected Lesions in Individuals at High Risk for Developing Pancreatic Cancer
Marcia Irene Canto et al.
Journal of Gastrointestinal Surgery https://doi.org/10.1007/s11605-019-04 - “It has been shown that some PDACs arise from well- defined precursor lesions such as microscopic pancreatic intraepithelial neoplasia (PanINs) or macroscopic intraductal papillary mucinous neoplasms (IPMNs)and detection of high-risk PDAC precursors might be suitable targets for screening.4 Consensus guidelines for the surveillance of HRI have been developed. The goal of screening and surveillance of HRI is to detect early stage pancreatic cancer and high-grade dysplasia (HGD) in precursor lesions (IPMN and PanIN).”
Surgical Outcomes After Pancreatic Resection of Screening-Detected Lesions in Individuals at High Risk for Developing Pancreatic Cancer
Marcia Irene Canto et al.
Journal of Gastrointestinal Surgery https://doi.org/10.1007/s11605-019-04 - “Some limitations of our study should be considered. First, the CAPS studies were conducted in an academic tertiary referral center with highly skilled endoscopists, pancreatic surgeons, radiologists, and pathologists, limiting generalizability of pancreatic surgery outside a specialized center with a multidisciplinary surveillance program. Second, the current study only reports the outcomes from patients diagnosed and followed at one hospital. Third, the proportion of patients in our CAPS cohort that underwent pancreatic surgery was small precluding more extensive evaluation of surgical management. Fourth, practice has evolved over the study period, with improved understanding, and better imaging technology.”
Surgical Outcomes After Pancreatic Resection of Screening-Detected Lesions in Individuals at High Risk for Developing Pancreatic Cancer
Marcia Irene Canto et al.
Journal of Gastrointestinal Surgery https://doi.org/10.1007/s11605-019-04
- “ A study led by Gangi and colleagues28 was conducted to test the value of imaging in early diagnosis of pancreatic cancer. For the study, 2 radiologists blindly interpreted 62 CT scans performed before a pancreatic cancer clinical diagnosis was made, and both radiologists agreed that suspicious findings were present in 50% of CT scans performed within 18 months prior to pancreatic cancer diagnosis.”
Current Status and Future Directions for Screening Patients at High Risk for Pancreatic Cancer Florencia McAllister et al. Gastroenterology & Hepatology Volume 13, Issue 5 May 2017;268-275 - “However, only 7% of CT scans performed more than 18 months prior to diagnosis showed suspicious lesions.28 e main early signs detected in the CT scans are pancreatic ductal dilation and cutoff. However, it should be noted that many patients had normal CT scans even 6 months before diagnosis, highlighting the importance of further developing novel imaging methods to detect smaller lesions. CT has a threshold for lesion detection of 0.3 to 0.5 cm.”
Current Status and Future Directions for Screening Patients at High Risk for Pancreatic Cancer Florencia McAllister et al. Gastroenterology & Hepatology Volume 13, Issue 5 May 2017;268-275-
Current Status and Future Directions for Screening Patients at High Risk for Pancreatic Cancer Florencia McAllister et al. Gastroenterology & Hepatology Volume 13, Issue 5 May 2017;268-275
Current Status and Future Directions for Screening Patients at High Risk for Pancreatic Cancer Florencia McAllister et al. Gastroenterology & Hepatology Volume 13, Issue 5 May 2017;268-275
- Genetic Mutations and Syndromes Associated With Increased Risk for Pancreatic Cancer
- “It has been reported that patients with lesions smaller than 10 mm, or minute lesions, have a 5-year survival rate as high as 60%, although the number of patients diagnosed with this tumor size is extremely low. These data indicate that early detection might have enormous importance in the disease prognosis. e goal of a surveillance program in asymptomatic patients should be the detection of stage I pancreatic cancer; ideally, the goal would be to detect premalignant lesions, which would dramatically increase survival rates.”
Current Status and Future Directions for Screening Patients at High Risk for Pancreatic Cancer McAllister F et al. Gastroenterology & Hepatology Volume 13, Issue 5 May 2017 - “The risk for pancreatic cancer is multifactorial, consisting of both environmental and inherited causes. Hereditary factors appear to play a key role in the development of pancreatic cancer in approximately 5% to 10% of all cases, including in individuals with an underlying germline gene mutation and those with a strong family history of pancreatic cancer.”
Current Status and Future Directions for Screening Patients at High Risk for Pancreatic Cancer McAllister F et al. Gastroenterology & Hepatology Volume 13, Issue 5 May 2017 - “As we strive to decrease the mortality rate of pancreatic cancer, we have made a good beginning by identifying the target population that would benefit from screening and have reached some agreement on the use of currently available imaging modalities. However, there is still a need for consensus on many issues, including when to start screening, the ideal method and interval of follow-up, and the optimal time to consider surgery.”
Current Status and Future Directions for Screening Patients at High Risk for Pancreatic Cancer McAllister F et al. Gastroenterology & Hepatology Volume 13, Issue 5 May 2017
