Screening for Early Pancreatic Neoplasia in High-Risk Individuals

A Prospective Controlled Study

Marcia Irene Canto, Michael Goggins, Ralph H. Hruban, Gloria M Petersen, Francis M. Giardiello, Charles Yeo, Elliott K. Fishman, Kieran Brune, Jennifer Axilbund, Constance Griffin, Syed Ali, Jeffrey Richman, Sanjay Jagannath, Sergey V. Kantsevoy, Anthony N. Kalloo

Research output: Contribution to journalArticle

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Abstract

Background & Aims: Individuals with a strong family history of pancreatic cancer and persons with Peutz-Jeghers syndrome (PJS) have an increased risk for pancreatic cancer. This study screened for early pancreatic neoplasia and compared the pancreatic abnormalities in high-risk individuals and control subjects. Methods: High-risk individuals with PJS or a strong family history of pancreatic cancer were prospectively evaluated with baseline and 12-month computed tomography (CT) scan and endoscopic ultrasonography (EUS). If EUS was abnormal, EUS-fine-needle aspiration and endoscopic retrograde cholangiopancreatography (ERCP) were performed. Surgery was offered to patients with potentially neoplastic lesions. Radiologic findings and pathologic diagnoses were compared. Patients undergoing EUS and/or ERCP for benign non-pancreatic indications were concurrently enrolled as control subjects. Results: Seventy-eight high-risk patients (72 from familial pancreatic cancer kindreds, 6 PJS) and 149 control patients were studied. To date, 8 patients with pancreatic neoplasia have been confirmed by surgery or fine-needle aspiration (10% yield of screening); 6 patients had 8 benign intraductal papillary mucinous neoplasms (IPMNs), 1 had an IPMN that progressed to invasive ductal adenocarcinoma, and 1 had pancreatic intraepithelial neoplasia. EUS and CT also diagnosed 3 patients with 5 extrapancreatic neoplasms. At EUS and ERCP abnormalities suggestive of chronic pancreatitis were more common in high-risk patients than in control subjects. Conclusions: Screening EUS and CT diagnosed significant asymptomatic pancreatic and extrapancreatic neoplasms in high-risk individuals. IPMN should be considered a part of the phenotype of familial pancreatic cancer. Abnormalities suggestive of chronic pancreatitis are identified more commonly at EUS and ERCP in high-risk individuals.

Original languageEnglish (US)
Pages (from-to)766-781
Number of pages16
JournalClinical Gastroenterology and Hepatology
Volume4
Issue number6
DOIs
StatePublished - Jun 2006

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Endosonography
Pancreatic Neoplasms
Prospective Studies
Endoscopic Retrograde Cholangiopancreatography
Peutz-Jeghers Syndrome
Neoplasms
Tomography
Chronic Pancreatitis
Fine Needle Biopsy
Adenocarcinoma
Phenotype

ASJC Scopus subject areas

  • Gastroenterology

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Screening for Early Pancreatic Neoplasia in High-Risk Individuals : A Prospective Controlled Study. / Canto, Marcia Irene; Goggins, Michael; Hruban, Ralph H.; Petersen, Gloria M; Giardiello, Francis M.; Yeo, Charles; Fishman, Elliott K.; Brune, Kieran; Axilbund, Jennifer; Griffin, Constance; Ali, Syed; Richman, Jeffrey; Jagannath, Sanjay; Kantsevoy, Sergey V.; Kalloo, Anthony N.

In: Clinical Gastroenterology and Hepatology, Vol. 4, No. 6, 06.2006, p. 766-781.

Research output: Contribution to journalArticle

Canto, MI, Goggins, M, Hruban, RH, Petersen, GM, Giardiello, FM, Yeo, C, Fishman, EK, Brune, K, Axilbund, J, Griffin, C, Ali, S, Richman, J, Jagannath, S, Kantsevoy, SV & Kalloo, AN 2006, 'Screening for Early Pancreatic Neoplasia in High-Risk Individuals: A Prospective Controlled Study', Clinical Gastroenterology and Hepatology, vol. 4, no. 6, pp. 766-781. https://doi.org/10.1016/j.cgh.2006.02.005
Canto, Marcia Irene ; Goggins, Michael ; Hruban, Ralph H. ; Petersen, Gloria M ; Giardiello, Francis M. ; Yeo, Charles ; Fishman, Elliott K. ; Brune, Kieran ; Axilbund, Jennifer ; Griffin, Constance ; Ali, Syed ; Richman, Jeffrey ; Jagannath, Sanjay ; Kantsevoy, Sergey V. ; Kalloo, Anthony N. / Screening for Early Pancreatic Neoplasia in High-Risk Individuals : A Prospective Controlled Study. In: Clinical Gastroenterology and Hepatology. 2006 ; Vol. 4, No. 6. pp. 766-781.
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abstract = "Background & Aims: Individuals with a strong family history of pancreatic cancer and persons with Peutz-Jeghers syndrome (PJS) have an increased risk for pancreatic cancer. This study screened for early pancreatic neoplasia and compared the pancreatic abnormalities in high-risk individuals and control subjects. Methods: High-risk individuals with PJS or a strong family history of pancreatic cancer were prospectively evaluated with baseline and 12-month computed tomography (CT) scan and endoscopic ultrasonography (EUS). If EUS was abnormal, EUS-fine-needle aspiration and endoscopic retrograde cholangiopancreatography (ERCP) were performed. Surgery was offered to patients with potentially neoplastic lesions. Radiologic findings and pathologic diagnoses were compared. Patients undergoing EUS and/or ERCP for benign non-pancreatic indications were concurrently enrolled as control subjects. Results: Seventy-eight high-risk patients (72 from familial pancreatic cancer kindreds, 6 PJS) and 149 control patients were studied. To date, 8 patients with pancreatic neoplasia have been confirmed by surgery or fine-needle aspiration (10{\%} yield of screening); 6 patients had 8 benign intraductal papillary mucinous neoplasms (IPMNs), 1 had an IPMN that progressed to invasive ductal adenocarcinoma, and 1 had pancreatic intraepithelial neoplasia. EUS and CT also diagnosed 3 patients with 5 extrapancreatic neoplasms. At EUS and ERCP abnormalities suggestive of chronic pancreatitis were more common in high-risk patients than in control subjects. Conclusions: Screening EUS and CT diagnosed significant asymptomatic pancreatic and extrapancreatic neoplasms in high-risk individuals. IPMN should be considered a part of the phenotype of familial pancreatic cancer. Abnormalities suggestive of chronic pancreatitis are identified more commonly at EUS and ERCP in high-risk individuals.",
author = "Canto, {Marcia Irene} and Michael Goggins and Hruban, {Ralph H.} and Petersen, {Gloria M} and Giardiello, {Francis M.} and Charles Yeo and Fishman, {Elliott K.} and Kieran Brune and Jennifer Axilbund and Constance Griffin and Syed Ali and Jeffrey Richman and Sanjay Jagannath and Kantsevoy, {Sergey V.} and Kalloo, {Anthony N.}",
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T1 - Screening for Early Pancreatic Neoplasia in High-Risk Individuals

T2 - A Prospective Controlled Study

AU - Canto, Marcia Irene

AU - Goggins, Michael

AU - Hruban, Ralph H.

AU - Petersen, Gloria M

AU - Giardiello, Francis M.

AU - Yeo, Charles

AU - Fishman, Elliott K.

AU - Brune, Kieran

AU - Axilbund, Jennifer

AU - Griffin, Constance

AU - Ali, Syed

AU - Richman, Jeffrey

AU - Jagannath, Sanjay

AU - Kantsevoy, Sergey V.

AU - Kalloo, Anthony N.

PY - 2006/6

Y1 - 2006/6

N2 - Background & Aims: Individuals with a strong family history of pancreatic cancer and persons with Peutz-Jeghers syndrome (PJS) have an increased risk for pancreatic cancer. This study screened for early pancreatic neoplasia and compared the pancreatic abnormalities in high-risk individuals and control subjects. Methods: High-risk individuals with PJS or a strong family history of pancreatic cancer were prospectively evaluated with baseline and 12-month computed tomography (CT) scan and endoscopic ultrasonography (EUS). If EUS was abnormal, EUS-fine-needle aspiration and endoscopic retrograde cholangiopancreatography (ERCP) were performed. Surgery was offered to patients with potentially neoplastic lesions. Radiologic findings and pathologic diagnoses were compared. Patients undergoing EUS and/or ERCP for benign non-pancreatic indications were concurrently enrolled as control subjects. Results: Seventy-eight high-risk patients (72 from familial pancreatic cancer kindreds, 6 PJS) and 149 control patients were studied. To date, 8 patients with pancreatic neoplasia have been confirmed by surgery or fine-needle aspiration (10% yield of screening); 6 patients had 8 benign intraductal papillary mucinous neoplasms (IPMNs), 1 had an IPMN that progressed to invasive ductal adenocarcinoma, and 1 had pancreatic intraepithelial neoplasia. EUS and CT also diagnosed 3 patients with 5 extrapancreatic neoplasms. At EUS and ERCP abnormalities suggestive of chronic pancreatitis were more common in high-risk patients than in control subjects. Conclusions: Screening EUS and CT diagnosed significant asymptomatic pancreatic and extrapancreatic neoplasms in high-risk individuals. IPMN should be considered a part of the phenotype of familial pancreatic cancer. Abnormalities suggestive of chronic pancreatitis are identified more commonly at EUS and ERCP in high-risk individuals.

AB - Background & Aims: Individuals with a strong family history of pancreatic cancer and persons with Peutz-Jeghers syndrome (PJS) have an increased risk for pancreatic cancer. This study screened for early pancreatic neoplasia and compared the pancreatic abnormalities in high-risk individuals and control subjects. Methods: High-risk individuals with PJS or a strong family history of pancreatic cancer were prospectively evaluated with baseline and 12-month computed tomography (CT) scan and endoscopic ultrasonography (EUS). If EUS was abnormal, EUS-fine-needle aspiration and endoscopic retrograde cholangiopancreatography (ERCP) were performed. Surgery was offered to patients with potentially neoplastic lesions. Radiologic findings and pathologic diagnoses were compared. Patients undergoing EUS and/or ERCP for benign non-pancreatic indications were concurrently enrolled as control subjects. Results: Seventy-eight high-risk patients (72 from familial pancreatic cancer kindreds, 6 PJS) and 149 control patients were studied. To date, 8 patients with pancreatic neoplasia have been confirmed by surgery or fine-needle aspiration (10% yield of screening); 6 patients had 8 benign intraductal papillary mucinous neoplasms (IPMNs), 1 had an IPMN that progressed to invasive ductal adenocarcinoma, and 1 had pancreatic intraepithelial neoplasia. EUS and CT also diagnosed 3 patients with 5 extrapancreatic neoplasms. At EUS and ERCP abnormalities suggestive of chronic pancreatitis were more common in high-risk patients than in control subjects. Conclusions: Screening EUS and CT diagnosed significant asymptomatic pancreatic and extrapancreatic neoplasms in high-risk individuals. IPMN should be considered a part of the phenotype of familial pancreatic cancer. Abnormalities suggestive of chronic pancreatitis are identified more commonly at EUS and ERCP in high-risk individuals.

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