Screening for pancreatic neoplasia in high-risk individuals: an EUS-based approach

• Published in: Clinical gastroenterology and hepatology Vol. 2; no. 7; pp. 606 - 621
• Main Authors: Canto, Marcia Irene, Goggins, Michael, Yeo, Charles J., Griffin, Constance, Axilbund, Jennifer E., Brune, Kieran, Ali, Syed Z., Jagannath, Sanjay, Petersen, Gloria M., Fishman, Elliot K., Piantadosi, Steven, Giardiello, Francis M., Hruban, Ralph H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2004
• Subjects: Age Distribution; Aged; Biopsy, Needle; Cholangiopancreatography, Endoscopic Retrograde - methods; Endosonography - methods; Feasibility Studies; Female; Genetic Predisposition to Disease; Humans; Immunohistochemistry; Male; Mass Screening - organization & administration; Middle Aged; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - epidemiology; Pancreatic Neoplasms - genetics; Pancreatic Neoplasms - pathology; Patient Compliance; Pedigree; Prevalence; Probability; Prognosis; Program Evaluation; Prospective Studies; Risk Assessment; Sex Distribution; Statistics, Nonparametric; Tomography, X-Ray Computed; CT; EUS; PanIN; FNA; ERCP; IPMN; NFPTR
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/S1542-3565(04)00244-7

Background & Aims: Relatives of patients with pancreatic cancer and persons with certain inherited syndromes are at increased risk for developing pancreatic cancer. We prospectively evaluated the feasibility of screening for pancreatic neoplasia in high-risk individuals. Methods: Individuals from familial pancreatic cancer kindreds and a patient with Peutz-Jeghers syndrome underwent screening endoscopic ultrasound (EUS). If the EUS was abnormal, EUS-guided fine-needle aspiration, endoscopic retrograde cholangiopancreatography (ERCP), and spiral computed tomography (CT) were performed. Patients with abnormalities suggesting neoplasia had surgery. Results: Thirty-eight patients were studied; 31 (mean age, 58 yr; 42% men) from kindreds with ≥3 affected with pancreatic cancer; 6 from kindreds with 2 affected relatives, 1 was a patient with Peutz-Jeghers syndrome. None had symptoms referable to the pancreas or suggestive of malignancy. Six pancreatic masses were found by EUS: 1 invasive ductal adenocarcinoma, 1 benign intraductal papillary mucinous neoplasm, 2 serous cystadenomas, and 2 nonneoplastic masses. Hence, the diagnostic yield for detecting clinically significant pancreatic neoplasms was 5.3% (2 of 38). The 1 patient with pancreatic cancer was treated and still is alive and disease-free >5 years after surgery. EUS changes similar to those associated with chronic pancreatitis were found, which were more common in patients with a history of regular alcohol intake ( P = 0.02), but also occurred in patients who did not consume alcohol. Screening also led to a new diagnosis and treatment of symptomatic upper-gastrointestinal conditions in 18.4% of patients. Conclusions: EUS-based screening of asymptomatic high-risk individuals can detect prevalent resectable pancreatic neoplasia but false-positive diagnoses also occur.