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 Fletcher, Gloria 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

360 Scopus citations

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

Keywords

  • Familial Pancreatic Cancer
  • IPMN
  • PanIN
  • Surveillance

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Canto, M. I., Hruban, R. H., Fishman, E. K., Kamel, I. R., Schulick, R., Zhang, Z., Topazian, M., Takahashi, N., Fletcher, J., Petersen, G., Klein, A. P., Axilbund, J., Griffin, C., Syngal, S., Saltzman, J. R., Mortele, K. J., Lee, J., Tamm, E., Vikram, R., ... 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