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PANCREATIC CANCER SCREENING IN HIGH-RISK PATIENTS: CAN WE DETECT RELEVANT FINDINGS?

Luisa Adán-Merino 1, Ana María Mora-Soler 1, Olivia Crivillén-Anguita 1, Celia Zaera-De la Fuente 1, Marta Roldán-Fernández 1, Francisco Garrido Gallego 1, Ángel Ponferrada-Díaz 1

Affiliations

1 Infanta Leonor University Hospital, Madrid, Spain

Summary

AI Generated

A single-center observational study of 35 high-risk patients undergoing pancreatic cancer screening with MRI and EUS detected neoplastic or preneoplastic lesions in 14.3% and other pancreatic abnormalities in 51.4% of cases.

Among 35 high-risk patients (median follow-up 23 months), solid tumors were detected in three patients (8.6%): two pancreatic ductal adenocarcinomas and one neuroendocrine tumor, with two individuals (5.7%) showing branch-duct intraductal papillary mucinous neoplasms.
Other pancreatic abnormalities were detected in 18 patients (51.4%), including chronic pancreatitis-like parenchymal changes (34.3%), peripancreatic lymph nodes (5.7%), and fatty pancreas (5.7%), while 12 patients (34.3%) had normal findings.
The most frequent hereditary syndrome was hereditary breast and ovarian cancer syndrome (54.3%), with BRCA2 mutation being the most common identifiable genetic factor (34.8%).
MRI and EUS showed discordance in 10 patients (28.6%), with EUS detecting more parenchymal changes (n=5), pancreatic steatosis (n=2), and one neuroendocrine tumor not described on MRI.
This material would be most relevant to gastroenterologists and oncologists managing surveillance programs for individuals at high genetic or familial risk of pancreatic cancer.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Pancreatic cancer (PC) screening can improve survival in high-risk patients by detecting preneoplastic lesions or early-stage tumors.
Surveillances is mainly based on annual magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS). However, little has been described regarding the possibility of finding other morphological changes that may be also important.

Aims & Methods

The aim of the study is to evaluate all the findings described in screening test and to analyze the correlation between these two screening techniques.
Descriptive observational single-center study that includes high-risk PC patients either due to family history (familial pancreatic cancer) or because they belong to hereditary syndromes, who have been undergone pancreatic cancer screening at our center from 2015 to 2023. Demographic variables and findings described in the EUS or MRI were collected.

Results

Thirty-five patients were included, with a mean age of 57.3 ± 8.2 years and a predominance of females (65.7%). Four patients (11.4%) were smokers, two were diabetic (5.7%), and one had a history of chronic pancreatitis (2.9%). The median follow-up time was 23 months (interquartile range 8-59 months).
The most frequent hereditary syndrome was hereditary breast and ovarian cancer syndrome (n=19, 54.3%), followed by familial atypical multiple mole melanoma syndrome (n=4; 11.4%). The BRCA2 mutation was the most common identifiable genetic factor (34.8%).
Regarding screening test findings, solid tumors were detected in three patients (8.6%) (Two stage I and IV adenocarcinomas and one stage I neuroendocrine tumor). In two individuals (5.7%) branch-duct intraductal papillary mucinous neoplasm were observed. Other pancreatic abnormalities were detected in 18 patients (51.4%) that include chronic pancreatitis-like parenchymal changes (34.3%), peripancreatic lymph nodes and fatty pancreas (5.7%). Finally, in 12 patients (34.3%) the screening tests were normal.
In relation to the concordance between MRI and EUS, in ten patients (28.6%) there was no agreement between these two techniques. EUS detected more parenchymal changes (n=5), pancreatic steatosis (n=2) and one neuroendocrine tumor that were not described on MRI. In contrast, MRI detected a cystic lesion and a pseudonodular enhancement that were not found on EUS.

Findings in screening techniques
Neoplasic/Preneoplastic lesions	Solid lesions Pancreatic ductal Adenocarcinoma Pancreatic Neuroendocrine tumour	3 (8.6%) 2 (5,7%) 1 ( 2,9%)
Neoplasic/Preneoplastic lesions	Branch-duct Intraductal papillary mucinous neoplasms	2 (5,7%)
Chronic pancreatitis-like parenchymal changes (n=12, 34.3%)	Non-shadowing hyperechoic strands	5 (14,3%)
	Dilated side branches ≥ 1 mm	2 (5,7%)
	Small cysts	5 (14,3%)
Chronic pancreatitis		2 (5,7%)
Fatty Pancreas		2 (5,7%)
Peripancreatic lymph nodes		2 (5,7%)
Normal findings		12 (34,3%)

Conclusion

Pancreatic cancer screening in high-risk individuals, detects neoplastic and preneoplastic lesions at a high rate.
Other findings, such as chronic pancreatitis-like parenchymal changes, peripancreatic lymph nodes or fatty pancreas, were also common in these patients
MRI and EUS have a good correlation, but EUS detects more parenchymal changes.

References

Goggins M, Overbeek KA, Brand R et al. Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium. Gut 2020; 69 (1): 7-17
Bogdanski AM, van Hooft JE, Boekestijn B, Bonsing BA, Wasser MNJM, Klatte DCF, van Leerdam ME. Aspects and outcomes of surveillance for individuals at high‑risk of pancreatic cancer. Fam Cancer 2024; 23(3):323-339.
Blackford AL, Canto MI, Dbouk M, Hruban RH, Katona BW, Chak A et al. Pancreatic Cancer Surveillance and Survival of High-Risk Individuals. JAMA Oncol. 2024;10(8):1087-1096.
Maurer E, Lehman B, Matthäi E, Denzer U, Figiel J, Jseinghaus M et al. Pancreatic cancer screening is effective in individuals at risk with predisposing germline gene variants, but not in gene variant‐negative familial pancreatic cancer families. United European Gastroenterol J 2024; 12 (9): 1211-1221