Screening for Pancreatic Neoplasia in Asymptomatic High Risk Individuals: A Prospective, Controlled Study

Abstract

Screening for Pancreatic Neoplasia in Asymptomatic High Risk Individuals: A Prospective, Controlled Study Marcia Canto, Michael Goggins, Sanjay Jagannath, Sergey Kantsevoy, Constance Griffin, Jennifer Axilbund, Kieran Brune, Gloria Petersen, Elliot Fishman, Charles Yeo, Ralph Hruban, Francis Giardiello, Anthony Kalloo Individuals from familial pancreatic cancer (PC) kindreds and persons with Peutz Jeghers syndrome (PJS) are at increased risk for PC. EUS and ERCP abnormalities associated with chronic pancreatitis (CP have been described in relatives from familial PC kindreds.AIM: To screen for early pancreatic neoplasia and to evaluate the radiologic pancreatic abnormalities in high-risk individuals compared to controls. METHODS:We prospectively evaluated high risk individuals with either: 1) > 1 first-degree relative with PC from kindreds with familial PC with > 2 affected members, or 2) Peutz-Jeghers syndrome. Each patient had screening with a dual phase, thin section CT scan and EUS, each interpreted in a blinded fashion. If EUS was abnormal, EUS-guided fine needle aspiration (FNA) and ERCP were performed. ERCP was performed by an endoscopist unaware of the clinical and radiologic findings. EUS and ERCP findings of high risk subjects were compared with those of normal controls. RESULTS:We studied 63 high risk patients (mean age 57 yrs, 47%male); 58 were from familial PC kindreds and 5 had Peutz-Jeghers syndrome. We also evaluated 130 normal controls (mean age 56 yrs, 44% male). No patients had symptoms referable to the pancreas, a suspicion of pancreatic cancer, or a history of pancreatitis. In the high risk group, a 1.5 cm pancreatic mass was detected in a PJS patient by both EUS and CT, which was surgically resected and found to be an intraductal papillary mucinous neoplasm with carcinoma-in-situ. Screening also detected 2 asymptomatic non-pancreatic cancers in the high risk group: a renal cell carcinoma (EUS and CT) and an ovarian cancer (CT only); both cancers were treated operatively. EUS showed CP (3 or more of 9 features) in 72% of high risk patients, which was significantly more common than in controls (14%, p<.01). ERCP was successful in 36/38 high-risk individuals; 67% had evidence of CP(mild=20%, moderate=44%, severe=2%) and 29% had one or more saccules. ERCP evidence of CP was more common in high risk subjects compared to controls (67% vs. 11%, p=.003). CP-like changes were present in 67% of high risk patients by both EUS and ERCP and only 1/3 of these patients regularly consumed alcohol. CONCLUSIONS: We identified significant asymptomatic pancreatic and extrapancreatic neoplasms by screening individuals at high risk of developing PC.Asymptomatic EUSandERCP features ofCP are common in such individuals and are not associated with alcohol intake.