Frequent detection of pancreatic lesions in asymptomatic high-risk individuals

Marcia Irene Canto, Ralph H. Hruban, Elliot K. Fishman, Ihab R. Kamel, Richard Schulick, Zhe Zhang, Mark Topazian, Naoki Takahashi, Joel Garland Fletcher, Gloria M Petersen, Alison P. Klein, Jennifer Axilbund, Constance Griffin, Sapna Syngal, John R. Saltzman, Koenraad J. Mortele, Jeffrey Lee, Eric Tamm, Raghunandan Vikram, Priya BhosaleDaniel Margolis, James Farrell, Michael Goggins

Research output: Contribution to journalArticle

350 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)796-804
Number of pages9
JournalGastroenterology
Volume142
Issue number4
DOIs
StatePublished - Apr 2012

Fingerprint

Pancreatic Neoplasms
Endosonography
Tomography
Magnetic Resonance Imaging
Neoplasms
Pancreatic Cyst
Germ-Line Mutation
Pancreatic Ducts
Cysts

Keywords

  • Familial Pancreatic Cancer
  • IPMN
  • PanIN
  • Surveillance

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Canto, M. I., Hruban, R. H., Fishman, E. K., Kamel, I. R., Schulick, R., Zhang, Z., ... Goggins, M. (2012). Frequent detection of pancreatic lesions in asymptomatic high-risk individuals. Gastroenterology, 142(4), 796-804. https://doi.org/10.1053/j.gastro.2012.01.005

Frequent detection of pancreatic lesions in asymptomatic high-risk individuals. / Canto, Marcia Irene; Hruban, Ralph H.; Fishman, Elliot K.; Kamel, Ihab R.; Schulick, Richard; Zhang, Zhe; Topazian, Mark; Takahashi, Naoki; Fletcher, Joel Garland; Petersen, Gloria M; 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.

In: Gastroenterology, Vol. 142, No. 4, 04.2012, p. 796-804.

Research output: Contribution to journalArticle

Canto, MI, Hruban, RH, Fishman, EK, Kamel, IR, Schulick, R, Zhang, Z, Topazian, M, Takahashi, N, Fletcher, JG, Petersen, GM, Klein, AP, Axilbund, J, Griffin, C, Syngal, S, Saltzman, JR, Mortele, KJ, Lee, J, Tamm, E, Vikram, R, Bhosale, P, Margolis, D, Farrell, J & Goggins, M 2012, 'Frequent detection of pancreatic lesions in asymptomatic high-risk individuals', Gastroenterology, vol. 142, no. 4, pp. 796-804. https://doi.org/10.1053/j.gastro.2012.01.005
Canto MI, Hruban RH, Fishman EK, Kamel IR, Schulick R, Zhang Z et al. Frequent detection of pancreatic lesions in asymptomatic high-risk individuals. Gastroenterology. 2012 Apr;142(4):796-804. https://doi.org/10.1053/j.gastro.2012.01.005
Canto, Marcia Irene ; Hruban, Ralph H. ; Fishman, Elliot K. ; Kamel, Ihab R. ; Schulick, Richard ; Zhang, Zhe ; Topazian, Mark ; Takahashi, Naoki ; Fletcher, Joel Garland ; Petersen, Gloria M ; 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. / Frequent detection of pancreatic lesions in asymptomatic high-risk individuals. In: Gastroenterology. 2012 ; Vol. 142, No. 4. pp. 796-804.
@article{1b9fd06216f0488c86cfe18eb4f8ac95,
title = "Frequent detection of pancreatic lesions in asymptomatic high-risk individuals",
abstract = "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.",
keywords = "Familial Pancreatic Cancer, IPMN, PanIN, Surveillance",
author = "Canto, {Marcia Irene} and Hruban, {Ralph H.} and Fishman, {Elliot K.} and Kamel, {Ihab R.} and Richard Schulick and Zhe Zhang and Mark Topazian and Naoki Takahashi and Fletcher, {Joel Garland} and Petersen, {Gloria M} and Klein, {Alison P.} and Jennifer Axilbund and Constance Griffin and Sapna Syngal and Saltzman, {John R.} and Mortele, {Koenraad J.} and Jeffrey Lee and Eric Tamm and Raghunandan Vikram and Priya Bhosale and Daniel Margolis and James Farrell and Michael Goggins",
year = "2012",
month = "4",
doi = "10.1053/j.gastro.2012.01.005",
language = "English (US)",
volume = "142",
pages = "796--804",
journal = "Gastroenterology",
issn = "0016-5085",
publisher = "W.B. Saunders Ltd",
number = "4",

}

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 Garland

AU - Petersen, Gloria M

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

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

UR - http://www.scopus.com/inward/record.url?scp=84859393143&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84859393143&partnerID=8YFLogxK

U2 - 10.1053/j.gastro.2012.01.005

DO - 10.1053/j.gastro.2012.01.005

M3 - Article

C2 - 22245846

AN - SCOPUS:84859393143

VL - 142

SP - 796

EP - 804

JO - Gastroenterology

JF - Gastroenterology

SN - 0016-5085

IS - 4

ER -