TY - JOUR
T1 - Frequent detection of pancreatic lesions in asymptomatic high-risk individuals
AU - Canto, Marcia Irene
AU - Hruban, Ralph H.
AU - Fishman, Elliot K.
AU - Kamel, Ihab R.
AU - Schulick, Richard
AU - Zhang, Zhe
AU - Topazian, Mark
AU - Takahashi, Naoki
AU - Fletcher, Joel
AU - Petersen, Gloria
AU - Klein, Alison P.
AU - Axilbund, Jennifer
AU - Griffin, Constance
AU - Syngal, Sapna
AU - Saltzman, John R.
AU - Mortele, Koenraad J.
AU - Lee, Jeffrey
AU - Tamm, Eric
AU - Vikram, Raghunandan
AU - Bhosale, Priya
AU - Margolis, Daniel
AU - Farrell, James
AU - Goggins, Michael
N1 - Funding Information:
Funding Supported by the National Cancer Institute Specialized Program in Research Excellence Clinical Intervention Supplement 2 P50 CA62924 , the Lustgarten Foundation for Pancreatic Cancer Research, the Michael Rolfe Foundation, Olympus Corporation, Cook Medical, Karp Family H.H. & M. Metals, Inc, Fund for Cancer Research, and ChiRhoClin.
PY - 2012/4
Y1 - 2012/4
N2 - Background & Aims: The risk of pancreatic cancer is increased in patients with a strong family history of pancreatic cancer or a predisposing germline mutation. Screening can detect curable, noninvasive pancreatic neoplasms, but the optimal imaging approach is not known. We determined the baseline prevalence and characteristics of pancreatic abnormalities using 3 imaging tests to screen asymptomatic, high-risk individuals (HRIs). Methods: We screened 225 asymptomatic adult HRIs at 5 academic US medical centers once, using computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasonography (EUS). We compared results in a blinded, independent fashion. Results: Ninety-two of 216 HRIs (42%) were found to have at least 1 pancreatic mass (84 cystic, 3 solid) or a dilated pancreatic duct (n = 5) by any of the imaging modalities. Fifty-one of the 84 HRIs with a cyst (60.7%) had multiple lesions, typically small (mean, 0.55 cm; range, 239 mm), in multiple locations. The prevalence of pancreatic lesions increased with age; they were detected in 14% of subjects younger than 50 years old, 34% of subjects 5059 years old, and 53% of subjects 6069 years old (P <.0001). CT, MRI, and EUS detected a pancreatic abnormality in 11%, 33.3%, and 42.6% of the HRIs, respectively. Among these abnormalities, proven or suspected neoplasms were identified in 85 HRIs (82 intraductal papillary mucinous neoplasms and 3 pancreatic endocrine tumors). Three of 5 HRIs who underwent pancreatic resection had high-grade dysplasia in less than 3 cm intraductal papillary mucinous neoplasms and in multiple intraepithelial neoplasias. Conclusions: Screening of asymptomatic HRIs frequently detects small pancreatic cysts, including curable, noninvasive high-grade neoplasms. EUS and MRI detect pancreatic lesions better than CT.
AB - Background & Aims: The risk of pancreatic cancer is increased in patients with a strong family history of pancreatic cancer or a predisposing germline mutation. Screening can detect curable, noninvasive pancreatic neoplasms, but the optimal imaging approach is not known. We determined the baseline prevalence and characteristics of pancreatic abnormalities using 3 imaging tests to screen asymptomatic, high-risk individuals (HRIs). Methods: We screened 225 asymptomatic adult HRIs at 5 academic US medical centers once, using computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasonography (EUS). We compared results in a blinded, independent fashion. Results: Ninety-two of 216 HRIs (42%) were found to have at least 1 pancreatic mass (84 cystic, 3 solid) or a dilated pancreatic duct (n = 5) by any of the imaging modalities. Fifty-one of the 84 HRIs with a cyst (60.7%) had multiple lesions, typically small (mean, 0.55 cm; range, 239 mm), in multiple locations. The prevalence of pancreatic lesions increased with age; they were detected in 14% of subjects younger than 50 years old, 34% of subjects 5059 years old, and 53% of subjects 6069 years old (P <.0001). CT, MRI, and EUS detected a pancreatic abnormality in 11%, 33.3%, and 42.6% of the HRIs, respectively. Among these abnormalities, proven or suspected neoplasms were identified in 85 HRIs (82 intraductal papillary mucinous neoplasms and 3 pancreatic endocrine tumors). Three of 5 HRIs who underwent pancreatic resection had high-grade dysplasia in less than 3 cm intraductal papillary mucinous neoplasms and in multiple intraepithelial neoplasias. Conclusions: Screening of asymptomatic HRIs frequently detects small pancreatic cysts, including curable, noninvasive high-grade neoplasms. EUS and MRI detect pancreatic lesions better than CT.
KW - Familial Pancreatic Cancer
KW - IPMN
KW - PanIN
KW - Surveillance
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U2 - 10.1053/j.gastro.2012.01.005
DO - 10.1053/j.gastro.2012.01.005
M3 - Article
C2 - 22245846
AN - SCOPUS:84859393143
SN - 0016-5085
VL - 142
SP - 796
EP - 804
JO - Gastroenterology
JF - Gastroenterology
IS - 4
ER -