Screening for early pancreatic neoplasia in high-risk individuals: a prospective controlled study.

Authors

• 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

Publication/Presentation Date

6-1-2006

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.

Volume

4

Issue

6

First Page

766

Last Page

781

ISSN

1542-3565

Published In/Presented At

Canto, M. I., Goggins, M., Hruban, R. H., Petersen, G. M., Giardiello, F. M., Yeo, C., Fishman, E. K., Brune, K., Axilbund, J., Griffin, C., Ali, S., Richman, J., Jagannath, S., Kantsevoy, S. V., & Kalloo, A. N. (2006). Screening for early pancreatic neoplasia in high-risk individuals: a prospective controlled study. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 4(6), 766–665. https://doi.org/10.1016/j.cgh.2006.02.005

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

16682259

Department(s)

Administration and Leadership

Document Type

Article