62 Surveillance of High-Risk Individuals for Pancreatic Cancer With EUS and MRI: A Meta-Analysis

Abstract

INTRODUCTION: Early detection of pancreatic cancer is of interest given the significant morbidity and mortality of this disease. The International Cancer of the Pancreas Screening (CAPS) Consortium guidelines recommend surveillance of high-risk individuals (HRI) with a history of familial pancreatic cancer or carriers of genetic cancer syndrome mutations. Surveillance is typically performed with endoscopic ultrasonography (EUS) and/or magnetic resonance imaging (MRI). The aim of this study is to assess the yield of pancreatic cancer surveillance programs of HRI and compare the yield of EUS and MRI. METHODS: The MEDLINE and Embase (Ovid) databases were searched for prospective studies published up to April 11, 2019 using EUS and/or MRI to screen HRI for pancreatic cancer. Baseline detection of focal pancreatic abnormalities, cystic lesions, solid lesions, high-risk lesions (defined as pancreatic intraepithelial neoplasia grade 3, intrapapillary mucinous neoplasia with high grade dysplasia, or T1N0M0 adenocarcinoma), and pancreatic adenocarcinoma were recorded, as were surgeries performed. Weighted pooled detection rates of outcomes were calculated and were compared between EUS and MRI using random effects modeling. RESULTS: A total of 1109 studies were reviewed and 24 were included in analysis, representing 2112 patients who underwent screening. The weighted pooled rate of focal pancreatic abnormalities detected on baseline screen by EUS (0.34, 95% CI 0.30–0.37) was significantly higher (P = 0.006) than by MRI (0.31, 95% CI 0.28–0.33). There were no significant differences between EUS and MRI for detection of other outcomes, including cysts, high-risk lesions, or pancreatic cancer (Table 1). The overall weighted pooled detection rate of high-risk lesions on baseline screening (regardless of imaging modality) was 0.0090 (95% CI 0.0022–0.016), corresponding to a number-needed-to-screen (NNS) of 111 patients to detect one high-risk lesion. The overall weighted pooled detection rate for pancreatic adenocarcinoma was 0.012 (95% CI 0.0051–0.018) and the surgery rate was 0.054 (95% CI 0.045–0.063) (Table 2). CONCLUSION: Surveillance programs are successful in detecting high-risk precursor lesions with a NNS compatible with existing screening and surveillance programs. No differences between EUS and MRI were noted in the detection rate of high-risk lesions or pancreatic cancer, which supports the use of either imaging study in surveillance programs.