Diagnostic Yield From Screening Asymptomatic Individuals at High Risk for Pancreatic Cancer: A Meta-analysis of Cohort Studies

Juan E. Corral, Karl F. Mareth, Douglas L. Riegert-Johnson, Ananya Das, Michael B Wallace

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background & Aims: There have been few studies of abdominal imaging screening of individuals at high risk for pancreatic cancer (based on family history or genetic variants). We performed a meta-analysis of prospective cohort studies to determine the diagnostic yield and outcomes of abdominal imaging screening for asymptomatic individuals at high risk. Methods: Through a systematic review of multiple electronic databases and conference proceedings through July 2017, we identified prospective cohort studies (>20 patients) of asymptomatic adults determined to be at high-risk of pancreatic cancer (lifetime risk >5%, including specific genetic-associated conditions) who were screened by endoscopic ultrasound (EUS) and/or magnetic resonance imaging (MRI) to detect pancreatic lesions. Our primary outcome was identification of high-risk pancreatic lesions (high-grade pancreatic intraepithelial neoplasia, high-grade dysplasia, or adenocarcinoma) at initial screening, and overall incidence during follow up. Summary estimates were reported as incidence rates per 100 patient-years. Results: We identified 19 studies comprising 7085 individuals at high risk for pancreatic cancer; of these, 1660 patients were evaluated by EUS and/or MRI. Fifty-nine high-risk lesions were identified (43 adenocarcinomas: 28 during the initial exam and 15 during follow-up surveillance) and 257 patients underwent pancreatic surgery. Based on our meta-analysis, the overall diagnostic yield screening for high-risk pancreatic lesions was 0.74 (95% CI, 0.33–1.14), with moderate heterogeneity among studies. The number needed to screen to identify 1 patient with a high-risk lesion was 135 (95% CI, 88–303). The diagnostic yield was similar for patients with different genetic features that increased risk, and whether patients were screened by EUS or MRI. Conclusions: Based on meta-analysis, 135 patients at high-risk for pancreatic cancer must be screened to identify 1 patient with a high-risk pancreatic lesion. Further studies are needed to determine whether screening reduces mortality and is cost effectiveness for individuals at high-risk of pancreatic cancer.

Original languageEnglish (US)
Pages (from-to)41-53
Number of pages13
JournalClinical Gastroenterology and Hepatology
Volume17
Issue number1
DOIs
StatePublished - Jan 1 2019

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Pancreatic Neoplasms
Meta-Analysis
Cohort Studies
Magnetic Resonance Imaging
Adenocarcinoma
Prospective Studies
Incidence
Cost-Benefit Analysis
Databases

Keywords

  • Early Detection
  • Pancreas
  • PanIN
  • Peutz-Jeghers Syndrome
  • Surveillance
  • Tumor

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Diagnostic Yield From Screening Asymptomatic Individuals at High Risk for Pancreatic Cancer : A Meta-analysis of Cohort Studies. / Corral, Juan E.; Mareth, Karl F.; Riegert-Johnson, Douglas L.; Das, Ananya; Wallace, Michael B.

In: Clinical Gastroenterology and Hepatology, Vol. 17, No. 1, 01.01.2019, p. 41-53.

Research output: Contribution to journalArticle

Corral, Juan E. ; Mareth, Karl F. ; Riegert-Johnson, Douglas L. ; Das, Ananya ; Wallace, Michael B. / Diagnostic Yield From Screening Asymptomatic Individuals at High Risk for Pancreatic Cancer : A Meta-analysis of Cohort Studies. In: Clinical Gastroenterology and Hepatology. 2019 ; Vol. 17, No. 1. pp. 41-53.
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AU - Das, Ananya

AU - Wallace, Michael B

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AB - Background & Aims: There have been few studies of abdominal imaging screening of individuals at high risk for pancreatic cancer (based on family history or genetic variants). We performed a meta-analysis of prospective cohort studies to determine the diagnostic yield and outcomes of abdominal imaging screening for asymptomatic individuals at high risk. Methods: Through a systematic review of multiple electronic databases and conference proceedings through July 2017, we identified prospective cohort studies (>20 patients) of asymptomatic adults determined to be at high-risk of pancreatic cancer (lifetime risk >5%, including specific genetic-associated conditions) who were screened by endoscopic ultrasound (EUS) and/or magnetic resonance imaging (MRI) to detect pancreatic lesions. Our primary outcome was identification of high-risk pancreatic lesions (high-grade pancreatic intraepithelial neoplasia, high-grade dysplasia, or adenocarcinoma) at initial screening, and overall incidence during follow up. Summary estimates were reported as incidence rates per 100 patient-years. Results: We identified 19 studies comprising 7085 individuals at high risk for pancreatic cancer; of these, 1660 patients were evaluated by EUS and/or MRI. Fifty-nine high-risk lesions were identified (43 adenocarcinomas: 28 during the initial exam and 15 during follow-up surveillance) and 257 patients underwent pancreatic surgery. Based on our meta-analysis, the overall diagnostic yield screening for high-risk pancreatic lesions was 0.74 (95% CI, 0.33–1.14), with moderate heterogeneity among studies. The number needed to screen to identify 1 patient with a high-risk lesion was 135 (95% CI, 88–303). The diagnostic yield was similar for patients with different genetic features that increased risk, and whether patients were screened by EUS or MRI. Conclusions: Based on meta-analysis, 135 patients at high-risk for pancreatic cancer must be screened to identify 1 patient with a high-risk pancreatic lesion. Further studies are needed to determine whether screening reduces mortality and is cost effectiveness for individuals at high-risk of pancreatic cancer.

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KW - PanIN

KW - Peutz-Jeghers Syndrome

KW - Surveillance

KW - Tumor

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