Frequent Detection of Pancreatic Lesions in Asymptomatic High-Risk Individuals
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 chara...
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| Published in | Gastroenterology (New York, N.Y. 1943) Vol. 142; no. 4; pp. 796 - 804 |
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| Main Authors | , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
01.04.2012
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| Subjects | |
| Online Access | Get full text |
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| Abstract | 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. |
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| AbstractList | 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. 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, 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. 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. 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).BACKGROUND & AIMSThe 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.METHODSWe 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.RESULTSNinety-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.CONCLUSIONSScreening of asymptomatic HRIs frequently detects small pancreatic cysts, including curable, noninvasive high-grade neoplasms. EUS and MRI detect pancreatic lesions better than CT. |
| Author | Vikram, Raghunandan Farrell, James Lee, Jeffrey Fletcher, Joel Mortele, Koenraad J. Canto, Marcia Irene Zhang, Zhe Topazian, Mark Syngal, Sapna Hruban, Ralph H. Axilbund, Jennifer Kamel, Ihab R. Goggins, Michael Tamm, Eric Margolis, Daniel Fishman, Elliot K. Griffin, Constance Bhosale, Priya Takahashi, Naoki Saltzman, John R. Schulick, Richard Klein, Alison P. Petersen, Gloria |
| Author_xml | – sequence: 1 givenname: Marcia Irene surname: Canto fullname: Canto, Marcia Irene email: mcanto@jhmi.edu organization: Department of Medicine (Division of Gastroenterology), The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, Maryland – sequence: 2 givenname: Ralph H. surname: Hruban fullname: Hruban, Ralph H. organization: Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, Maryland – sequence: 3 givenname: Elliot K. surname: Fishman fullname: Fishman, Elliot K. organization: Department of Radiology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, Maryland – sequence: 4 givenname: Ihab R. surname: Kamel fullname: Kamel, Ihab R. organization: Department of Radiology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, Maryland – sequence: 5 givenname: Richard surname: Schulick fullname: Schulick, Richard organization: Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, Maryland – sequence: 6 givenname: Zhe surname: Zhang fullname: Zhang, Zhe organization: Department of Biostatistics, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, Maryland – sequence: 7 givenname: Mark surname: Topazian fullname: Topazian, Mark organization: Department of Medicine (Division of Gastroenterology), Mayo Clinic, Rochester, Minnesota – sequence: 8 givenname: Naoki surname: Takahashi fullname: Takahashi, Naoki organization: Department of Radiology, Mayo Clinic, Rochester, Minnesota – sequence: 9 givenname: Joel surname: Fletcher fullname: Fletcher, Joel organization: Department of Radiology, Mayo Clinic, Rochester, Minnesota – sequence: 10 givenname: Gloria surname: Petersen fullname: Petersen, Gloria organization: Department of Epidemiology, Mayo Clinic, Rochester, Minnesota – sequence: 11 givenname: Alison P. surname: Klein fullname: Klein, Alison P. organization: Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, Maryland – sequence: 12 givenname: Jennifer surname: Axilbund fullname: Axilbund, Jennifer organization: Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, Maryland – sequence: 13 givenname: Constance surname: Griffin fullname: Griffin, Constance organization: Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, Maryland – sequence: 14 givenname: Sapna surname: Syngal fullname: Syngal, Sapna organization: Department of Medicine (Division of Gastroenterology), Dana Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts – sequence: 15 givenname: John R. surname: Saltzman fullname: Saltzman, John R. organization: Department of Medicine (Division of Gastroenterology), Dana Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts – sequence: 16 givenname: Koenraad J. surname: Mortele fullname: Mortele, Koenraad J. organization: Department of Medicine (Division of Gastroenterology), Dana Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts – sequence: 17 givenname: Jeffrey surname: Lee fullname: Lee, Jeffrey organization: Department of Medicine (Division of Gastroenterology), MD Anderson Cancer Center, Houston, Texas – sequence: 18 givenname: Eric surname: Tamm fullname: Tamm, Eric organization: Department of Radiology, MD Anderson Cancer Center, Houston, Texas – sequence: 19 givenname: Raghunandan surname: Vikram fullname: Vikram, Raghunandan organization: Department of Radiology, MD Anderson Cancer Center, Houston, Texas – sequence: 20 givenname: Priya surname: Bhosale fullname: Bhosale, Priya organization: Department of Radiology, MD Anderson Cancer Center, Houston, Texas – sequence: 21 givenname: Daniel surname: Margolis fullname: Margolis, Daniel organization: Department of Radiology, University of California Los Angeles, Los Angeles, California – sequence: 22 givenname: James surname: Farrell fullname: Farrell, James organization: Department of Medicine (Division of Gastroenterology), University of California Los Angeles, Los Angeles, California – sequence: 23 givenname: Michael surname: Goggins fullname: Goggins, Michael organization: Department of Medicine (Division of Gastroenterology), The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, Maryland |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/22245846$$D View this record in MEDLINE/PubMed |
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| Snippet | The risk of pancreatic cancer is increased in patients with a strong family history of pancreatic cancer or a predisposing germline mutation. Screening can... Background & Aims The risk of pancreatic cancer is increased in patients with a strong family history of pancreatic cancer or a predisposing germline mutation.... |
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| SubjectTerms | 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 |
| Title | Frequent Detection of Pancreatic Lesions in Asymptomatic High-Risk Individuals |
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