TY - JOUR
T1 - Screening for pancreatic neoplasia in high-risk individuals
T2 - An EUS-based approach
AU - Canto, Marcia Irene
AU - Goggins, Michael
AU - Yeo, Charles J.
AU - Griffin, Constance
AU - Axilbund, Jennifer E.
AU - Brune, Kieran
AU - Ali, Syed Z.
AU - Jagannath, Sanjay
AU - Petersen, Gloria M.
AU - Fishman, Elliot K.
AU - Piantadosi, Steven
AU - Giardiello, Francis M.
AU - Hruban, Ralph H.
N1 - Funding Information:
Supported in part by the National Cancer Institute Specialized Program in Research Excellence (SPORE) grant number 2 P50 CA62924.
PY - 2004/7
Y1 - 2004/7
N2 - Background & Aims: Relatives of patients with pancreatic cancer and persons with certain inherited syndromes are at increased risk for developing pancreatic cancer. We prospectively evaluated the feasibility of screening for pancreatic neoplasia in high-risk individuals. Methods: Individuals from familial pancreatic cancer kindreds and a patient with Peutz-Jeghers syndrome underwent screening endoscopic ultrasound (EUS). If the EUS was abnormal, EUS-guided fine-needle aspiration, endoscopic retrograde cholangiopancreatography (ERCP), and spiral computed tomography (CT) were performed. Patients with abnormalities suggesting neoplasia had surgery. Results: Thirty-eight patients were studied; 31 (mean age, 58 yr; 42% men) from kindreds with ≥3 affected with pancreatic cancer; 6 from kindreds with 2 affected relatives, 1 was a patient with Peutz-Jeghers syndrome. None had symptoms referable to the pancreas or suggestive of malignancy. Six pancreatic masses were found by EUS: 1 invasive ductal adenocarcinoma, 1 benign intraductal papillary mucinous neoplasm, 2 serous cystadenomas, and 2 nonneoplastic masses. Hence, the diagnostic yield for detecting clinically significant pancreatic neoplasms was 5.3% (2 of 38). The 1 patient with pancreatic cancer was treated and still is alive and disease-free >5 years after surgery. EUS changes similar to those associated with chronic pancreatitis were found, which were more common in patients with a history of regular alcohol intake (P = 0.02), but also occurred in patients who did not consume alcohol. Screening also led to a new diagnosis and treatment of symptomatic upper-gastrointestinal conditions in 18.4% of patients. Conclusions: EUS-based screening of asymptomatic high-risk individuals can detect prevalent resectable pancreatic neoplasia but false-positive diagnoses also occur.
AB - Background & Aims: Relatives of patients with pancreatic cancer and persons with certain inherited syndromes are at increased risk for developing pancreatic cancer. We prospectively evaluated the feasibility of screening for pancreatic neoplasia in high-risk individuals. Methods: Individuals from familial pancreatic cancer kindreds and a patient with Peutz-Jeghers syndrome underwent screening endoscopic ultrasound (EUS). If the EUS was abnormal, EUS-guided fine-needle aspiration, endoscopic retrograde cholangiopancreatography (ERCP), and spiral computed tomography (CT) were performed. Patients with abnormalities suggesting neoplasia had surgery. Results: Thirty-eight patients were studied; 31 (mean age, 58 yr; 42% men) from kindreds with ≥3 affected with pancreatic cancer; 6 from kindreds with 2 affected relatives, 1 was a patient with Peutz-Jeghers syndrome. None had symptoms referable to the pancreas or suggestive of malignancy. Six pancreatic masses were found by EUS: 1 invasive ductal adenocarcinoma, 1 benign intraductal papillary mucinous neoplasm, 2 serous cystadenomas, and 2 nonneoplastic masses. Hence, the diagnostic yield for detecting clinically significant pancreatic neoplasms was 5.3% (2 of 38). The 1 patient with pancreatic cancer was treated and still is alive and disease-free >5 years after surgery. EUS changes similar to those associated with chronic pancreatitis were found, which were more common in patients with a history of regular alcohol intake (P = 0.02), but also occurred in patients who did not consume alcohol. Screening also led to a new diagnosis and treatment of symptomatic upper-gastrointestinal conditions in 18.4% of patients. Conclusions: EUS-based screening of asymptomatic high-risk individuals can detect prevalent resectable pancreatic neoplasia but false-positive diagnoses also occur.
KW - CT
KW - ERCP
KW - EUS
KW - FNA
KW - IPMN
KW - NFPTR
KW - National Familial Pancreas Tumor Registry
KW - PanIN
KW - computed tomography
KW - endoscopic retrograde cholangiopancreatography
KW - endoscopic ultrasonography
KW - fine-needle aspiration
KW - intraductal papillary mucinous neoplasm
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UR - http://www.scopus.com/inward/citedby.url?scp=3042525898&partnerID=8YFLogxK
U2 - 10.1016/S1542-3565(04)00244-7
DO - 10.1016/S1542-3565(04)00244-7
M3 - Article
C2 - 15224285
AN - SCOPUS:3042525898
SN - 1542-3565
VL - 2
SP - 606
EP - 621
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 7
ER -