Frequent Detection of Pancreatic Lesions in Asymptomatic High-Risk Individuals

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 142; no. 4; pp. 796 - 804
• Main Authors: Canto, Marcia Irene, Hruban, Ralph H., Fishman, Elliot K., Kamel, Ihab R., Schulick, Richard, Zhang, Zhe, Topazian, Mark, Takahashi, Naoki, Fletcher, Joel, Petersen, Gloria, Klein, Alison P., Axilbund, Jennifer, Griffin, Constance, Syngal, Sapna, Saltzman, John R., Mortele, Koenraad J., Lee, Jeffrey, Tamm, Eric, Vikram, Raghunandan, Bhosale, Priya, Margolis, Daniel, Farrell, James, Goggins, Michael
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2012
• Subjects: Academic Medical Centers; Aged; Asymptomatic Diseases; Chi-Square Distribution; Diagnostic Imaging - methods; Endosonography; Familial Pancreatic Cancer; Female; Gastroenterology and Hepatology; Genetic Predisposition to Disease; Heredity; Humans; IPMN; Logistic Models; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Pancreatic Cyst - diagnosis; Pancreatic Cyst - epidemiology; Pancreatic Cyst - genetics; Pancreatic Cyst - pathology; Pancreatic Cyst - surgery; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - epidemiology; Pancreatic Neoplasms - genetics; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; PanIN; Pedigree; Predictive Value of Tests; Prevalence; Prognosis; Prospective Studies; Risk Assessment; Risk Factors; Surveillance; Tomography, X-Ray Computed; United States - epidemiology; United States; BD; EUS; MRI; IPMN; FAMMM; CT; PC; Surveillance; MRCP; PanIN; FPC; PJS; Familial Pancreatic Cancer; CAPS; HRI; high-risk individuals; magnetic resonance imaging; pancreatic cancer; endoscopic ultrasonography; computed tomography; branch duct; intraductal papillary mucinous neoplasm; American Cancer of the Pancreas Screening Consortium; Peutz–Jeghers syndrome; familial atypical multiple mole melanoma; pancreatic intraepithelial neoplasia; magnetic resonance cholangiopancreatography
• ISSN: 0016-5085; 1528-0012; 1528-0012
• DOI: 10.1053/j.gastro.2012.01.005

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). 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. 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, 2–39 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 50–59 years old, and 53% of subjects 60–69 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. Screening of asymptomatic HRIs frequently detects small pancreatic cysts, including curable, noninvasive high-grade neoplasms. EUS and MRI detect pancreatic lesions better than CT.