Cancer Of The Pancreas Screening Research Articles

Using Tumor Marker Gene Variants to Improve the Diagnostic Accuracy of DUPAN-2 and Carbohydrate Antigen 19-9 for Pancreatic Cancer.

Circulating carbohydrate antigen 19-9 (CA19-9) levels reflect FUT3 and FUT2 fucosyltransferase activity. Measuring the related glycan, DUPAN-2, can be useful in individuals unable to synthesize CA19-9. We hypothesized that similar to CA19-9, FUT functional groups determined by variants in FUT3 and FUT2 influence DUPAN-2 levels, and having tumor marker reference ranges for each functional group would improve diagnostic performance. Using a training/validation study design, FUT2/FUT3 genotypes were determined in 938 individuals from Johns Hopkins Hospital: 607 Cancer of the Pancreas Screening (CAPS) study subjects with unremarkable pancreata and 331 with pancreatic ductal adenocarcinoma (PDAC). Serum DUPAN-2 and CA19-9 levels were measured by immunoassay. In controls, three functional FUT groups were identified with significant differences in DUPAN-2 levels: FUT3-intact, FUT3-null/FUT2-intact, and FUT3-null/FUT2-null. DUPAN-2 training set diagnostic cutoffs for each FUT group yielded higher diagnostic sensitivity in the validation set for patients with stage I/II PDAC than uniform cutoffs (60.4% [95% CI, 50.2 to 70.0] v 39.8% [30.0 to 49.8]), at approximately 99% (96.7 to 99.6) specificity. Combining FUT/CA19-9 and FUT/DUPAN-2 tests yielded 78.4% (72.3 to 83.7) sensitivity for stage I/II PDAC, at 97.7% (95.3 to 99.1) specificity in the combined sets, with higher AUC (stage I/II: 0.960 v 0.935 for CA19-9 + DUPAN-2 without the FUT test; P < .001); for stage I PDAC, sensitivity was 62.0% (49.1 to 73.2; AUC, 0.919 v 0.883; P = .03). CA19-9 levels in FUT3-null/FUT2-null PDAC subjects were higher than in FUT3-null/FUT2-intact subjects (median/IQR; 24.9/57.4 v <1/2.3 U/mL; P = .0044). In a simulated CAPS cohort, AUC precision recall (AUCPR) scores were 0.51 for CA19-9 alone, 0.64 for FUT/CA19-9, 0.73 for CA19-9/DUPAN-2, and 0.84 for FUT/CA19-9/DUPAN-2. Using a tumor marker gene test to individualize CA19-9 and DUPAN-2 reference ranges achieves high diagnostic performance for stage I/II pancreatic cancer.

A311 EFFICACY OF PANCREATIC CANCER SCREENING IN HIGH RISK INDIVIDUALS

Abstract Background Pancreatic cancer (PC) is the 11th most prevalent cancer in Canada with about 6900 new cases in 2021. Due to late diagnosis, it is the 4th largest cause of cancer related mortality in Canada. Despite advances in diagnosis and treatment over the past decade, the 5-year survival remains ampersand:003C10%, making pancreatic cancer one of the most lethal malignancies worldwide. However, if detected early, the 5-year survival increases to 80%. The incidence of pancreatic cancer remains low. Therefore, the International Cancer of the Pancreas Screening (CAPS) consortium do not recommend screening everyone. Selective screening in high-risk individuals may be effective in early detection and treatment of pancreatic cancer. Aims 1. To determine the characteristics of patients undergoing PC screening at a single tertiary care center in Vancouver. 2. To determine the frequency of disease progression and outcomes in patients diagnosed with high-risk lesions during screening. Methods Retrospective chart review was performed for patients who were screened between January 1, 2005 to June 30, 2023. As per consensus from the CAPS Consortium, patients with at least 2 close relatives with PC, and those with predisposing genetic mutations screened using endoscopic ultrasound (EUS) and/or magnetic resonance imaging (MRI) were included in the study. Clinical data, such as age, tobacco use, genetic risk, endoscopic findings, and outcomes, such as disease progression, were collected. Statistical analysis was performed using Rstudio and Microsoft Excel. Results 73 patients were included, with 42 included due to pathogenic germline mutations, and 31 with familial pancreatic cancer. Most were female (52, 71.2%). Median age in the study was 54 years (range 24-74 years) at initial screening. 66 patients (90.4%) received an EUS and 7 patients (9.6%) received MRI for initial screening. At the time of initial screening. 74.6% of patients had a normal pancreas. 6 patients (8.2%) were found to have neoplastic lesions, e.g. ampulloma, neuroendocrine tumour or adenocarcinoma at initial screening and referred for surgery. In the median follow up time of 67.9 months (range 0-168.1 months), 6 patients were noted to have disease progression, 4 of which had increase in cyst size without any other worrisome features. 2 patients had progression to malignancy. 1 of those patients received chemotherapy and surgical resection and remains alive; the other patient was lost of follow up due to geographical move. Conclusions Pancreatic cancer screening in high risk individuals is effective in early detection and treatment. Given lower incidence of pancreatic cancer, we likely need additional patient enrolment to observe a significant improvement in patient outcomes. Funding Agencies None

Surveillance of Individuals at High Risk of Developing Pancreatic Cancer: A Prevalence Meta-analysis to Estimate the Rate of Low-yield Surgery.

To quantify the rate of low-yield surgery, defined as no high-grade dysplastic precursor lesions or T1N0M0 pancreatic cancer at pathology, during pancreatic cancer surveillance. Global efforts have been made in pancreatic cancer surveillance to anticipate the diagnosis of pancreatic cancer at an early stage and improve survival in high-risk individuals (HRIs) with a hereditary predisposition. The negative impact of pancreatic cancer surveillance when surgery is performed for low-grade dysplasia or a non-neoplastic condition is not well quantified. A systematic search and prevalence meta-analysis was performed for studies reporting surgery with final diagnoses other than those defined by the Cancer of the Pancreas Screening (CAPS) goals from January 2000 to July 2023. The secondary outcome was the pooled proportion of final diagnoses matching the CAPS goals (PROSPERO: #CRD42022300408). Twenty-three articles with 5027 patients (median 109 patients/study, interquartile range 251) were included. The pooled prevalence of low-yield surgery was 2.1% (95% CI: 0.9-3.7, I2 : 83%). In the subgroup analysis, this prevalence was nonsignificantly higher in studies that only included familial pancreatic cancer subjects without known pathogenic variants, compared with those enrolling pathogenic variant carriers. No effect modifiers were found. Overall, the pooled prevalence of subjects under surveillance who had a pancreatic resection that contained target lesions was 0.8% (95% CI, 0.3-1.5, I2 : 24%]. The temporal analysis showed that the rate of low-yield surgeries decreased in the last decades and stabilized at around 1% (test for subgroup differences P <0.01). The risk of "low-yield" surgery during pancreatic cancer surveillance is relatively low but should be thoroughly discussed with individuals under surveillance.

Recommendations for a More Organized and Effective Approach to the Early Detection of Pancreatic Cancer From the PRECEDE (Pancreatic Cancer Early Detection) Consortium

Recommendations for a More Organized and Effective Approach to the Early Detection of Pancreatic Cancer From the PRECEDE (Pancreatic Cancer Early Detection) Consortium

ID: 3525490 PROSPECTIVE ASSESSMENT OF NEW ONSET DIABETES MELLITUS AND PRE DIABETES MELLITUS IN PATIENTS UNDERGOING PANCREATIC CANCER SCREENING

Latest International Cancer of the Pancreas Screening (CAPS) Consortium guidelines recommend high-risk individuals for pancreatic cancer undergo annual screening for new onset diabetes mellitus (NODM). The goal of our study was to determine feasibility, and proportion of patients undergoing pancreatic cancer screening who were diagnosed with pre-diabetes mellitus (pre-DM) or NODM. We also sought to determine if patients with abnormal blood sugar were more likely to have abnormal findings on pancreas exam during endoscopic ultrasound (EUS).

Guidelines on management of pancreatic cysts detected in high-risk individuals: An evaluation of the 2017 Fukuoka guidelines and the 2020 International Cancer of the Pancreas Screening (CAPS) consortium statements

BackgroundObjectives: Pancreatic cysts are frequently detected in high-risk individuals (HRI) undergoing surveillance for pancreatic cancer. The International Cancer of the Pancreas Screening (CAPS) Consortium developed consensus recommendations for surgical resection of pancreatic cysts in HRI that are similar to the Fukuoka guidelines used for the management of sporadic cysts. We compared the performance characteristics of CAPS criteria for pancreatic cyst management in HRI with the Fukuoka guidelines originally designed for the management of cysts in non-HRI. MethodsUsing prospectively collected data from CAPS studies, we determined for each patient with resected screen-detected cyst(s) whether Fukuoka guidelines or CAPS consensus statements would have recommended surgery. We compared sensitivity, specificity, PPV, NPV, and Receiver Operator Characteristics (ROC) curves of these guidelines at predicting the presence of high-grade dysplasia or invasive cancer in pancreatic cysts. Results356/732 HRI had ≥ one pancreatic cyst detected; 24 had surgery for concerning cystic lesions. The sensitivity, specificity, PPV, and NPV for the Fukuoka criteria were 40%, 85%, 40%, and 85%, while those of the CAPS criteria were 60%, 85%, 50%, 89%, respectively. ROC curve analyses showed no significant difference between the Fukuoka and CAPS criteria. ConclusionsIn HRI, the CAPS and Fukuoka criteria are moderately specific, but not sufficiently sensitive for detecting advanced neoplasia in cystic lesions. New approaches are needed to guide the surgical management of cystic lesions in HRI.

Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium

Background and aimThe International Cancer of the Pancreas Screening Consortium met in 2018 to update its consensus recommendations for the management of individuals with increased risk of pancreatic cancer based...

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

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.

Surveillance for pancreatic cancer in high‐risk individuals

BackgroundSurveillance of individuals at high risk of pancreatic ductal adenocarcinoma (PDAC) and its precursors might lead to better outcomes. The aim of this study was to determine the prevalence and outcomes of PDAC and high‐risk neoplastic precursor lesions among such patients participating in surveillance programmes.MethodsA multicentre study was conducted through the International CAncer of the Pancreas Screening (CAPS) Consortium Registry to identify high‐risk individuals who had undergone pancreatic resection or progressed to advanced PDAC while under surveillance. High‐risk neoplastic precursor lesions were defined as: pancreatic intraepithelial neoplasia (PanIN) 3, intraductal papillary mucinous neoplasia (IPMN) with high‐grade dysplasia, and pancreatic neuroendocrine tumours at least 2 cm in diameter.ResultsOf 76 high‐risk individuals identified in 11 surveillance programmes, 71 had undergone surgery and five had been diagnosed with inoperable PDAC. Of the 71 patients who underwent resection, 32 (45 per cent) had PDAC or a high‐risk precursor (19 PDAC, 4 main‐duct IPMN, 4 branch‐duct IPMN, 5 PanIN‐3); the other 39 patients had lesions thought to be associated with a lower risk of neoplastic progression. Age at least 65 years, female sex, carriage of a gene mutation and location of a lesion in the head/uncinate region were associated with high‐risk precursor lesions or PDAC. The survival of high‐risk individuals with low‐risk neoplastic lesions did not differ from that in those with high‐risk precursor lesions. Survival was worse among patients with PDAC. There was no surgery‐related mortality.ConclusionA high proportion of high‐risk individuals who had surgical resection for screening‐ or surveillance‐detected pancreatic lesions had a high‐risk neoplastic precursor lesion or PDAC at the time of surgery. Survival was better in high‐risk individuals who had either low‐ or high‐risk neoplastic precursor lesions compared with that in patients who developed PDAC.

Surgical Outcomes After Pancreatic Resection of Screening-Detected Lesions in Individuals at High Risk for Developing Pancreatic Cancer

BackgroundScreening high-risk individuals (HRI) can detect potentially curable pancreatic ductal adenocarcinoma (PDAC) and its precursors. We describe the outcomes of high-risk individuals (HRI) after pancreatic resection of screen-detected neoplasms. MethodsAsymptomatic HRI enrolled in the prospective Cancer of the Pancreas Screening (CAPS) studies from 1998 to 2014 based on family history or germline mutations undergoing surveillance for at least 6 months were included. Pathologic diagnoses, hospital length of stay, incidence of diabetes mellitus, operative morbidity, need for repeat operation, and disease-specific mortality were determined. ResultsAmong 354 HRI, 48 (13.6%) had 57 operations (distal pancreatectomy (31), Whipple (20), and total pancreatectomy (6)) for suspected pancreatic neoplasms presenting as a solid mass (22), cystic lesion(s) (25), or duct stricture (1). The median length of stay was 7 days (IQR 5–11). Nine of the 42 HRI underwent completion pancreatectomy for a new lesion after a median of 3.8 years (IQR 2.5–7.6). Postoperative complications developed in 17 HRI (35%); there were no perioperative deaths. New-onset diabetes mellitus after partial resection developed in 20% of HRI. Fourteen PDACs were diagnosed, 11 were screen-detected, 10 were resectable, and 9 had an R0 resection. Metachronous PDAC developed in remnant pancreata of 2 HRI. PDAC-related mortality was 4/10 (40%), with 90% 1-year survival and 60% 5-year survival, respectively. ConclusionsScreening HRI can detect PDAC with a high resectability rate. Surgical treatment is associated with a relatively short length of stay and low readmission rate, acceptable morbidity, zero 90-day mortality, and significant long-term survival. Clinical Trial Registration NumberNCT2000089

Updated international Cancer of the Pancreas Screening (CAPS) consortium guidelines on the management of patients with increased risk for familial pancreatic cancer

Updated international Cancer of the Pancreas Screening (CAPS) consortium guidelines on the management of patients with increased risk for familial pancreatic cancer

Sa1350 – Updated International Cancer of the Pancreas Screening (CAPS) Consortium Guidelines on the Management of Patients with Increased Risk for Familial Pancreatic Cancer

Sa1350 – Updated International Cancer of the Pancreas Screening (CAPS) Consortium Guidelines on the Management of Patients with Increased Risk for Familial Pancreatic Cancer

Chronic pancreatitis changes in high-risk individuals for pancreatic ductal adenocarcinoma

Pancreatic intraepithelial neoplasia is associated with chronic pancreatitis (CP) changes on EUS. The objective of this study was to determine whether CP changes were more common in high-risk individuals (HRIs) than in control subjects and whether these changes differed among higher-risk subsets of HRIs. HRIs and control subjects were identified from an endoscopy database. HRIs were defined as having predisposing mutations or a family history (FH) of pancreatic ductal adenocarcinoma. HRIs were classified as vHRIs who met Cancer of the Pancreas Screening (CAPS) criteria for high risk and mHRIs who did not. Multivariable logistic regression was used to adjust for confounders and CP risk factors. Sixty-five HRIs (44 vHRIs, 21 mHRIs) and 118 control subjects were included. HRIs were included for FH (25), Lynch syndrome (5), Peutz-Jeghers syndrome (2), and mutations in BRCA1/2 (26), PALB2 (3), ATM (3), and CDKN2A (1). After adjustment for relevant variables, HRIs were 16 times more likely to exhibit 3 or more CP changes than control subjects (95% confidence interval, 2.6-97.0; P= .003). HRIs were also more likely to have hypoechoic foci (odds ratio, 8.0; 95% confidence interval, 1.9-32.9; P= .004). vHRIs and mHRIs did not differ in frequency of 3 or more CP changes on EUS. HRIs were more likely to exhibit CP changes and hypoechoic foci on EUS compared with control subjects. HRIs with these findings may require closer surveillance. HRIs who did or did not meet CAPS criteria did not differ with regard to CP findings, supporting a more inclusive approach to screening.

229 - Surgical and Patient-Centered Outcomes after Pancreatic Resection in High-Risk Individuals for Pancreatic Cancer: A 20-Year Prospective Cancer of the Pancreas Screening (CAPS) Cohort Study

229 - Surgical and Patient-Centered Outcomes after Pancreatic Resection in High-Risk Individuals for Pancreatic Cancer: A 20-Year Prospective Cancer of the Pancreas Screening (CAPS) Cohort Study

Sa1316 - Predictors of Neoplastic Progression in High-Risk Individuals Undergoing Surveillance for Pancreatic Cancer: Lessons from the First 16 Years of the Cancer of the Pancreas Screening (CAPS) Program

Sa1316 - Predictors of Neoplastic Progression in High-Risk Individuals Undergoing Surveillance for Pancreatic Cancer: Lessons from the First 16 Years of the Cancer of the Pancreas Screening (CAPS) Program

EUS and MRI/MRCP Findings in Pancreatic Cancer Screening for Individuals Who Harbor a BRCA2 Deleterious Germline Mutation

Introduction: Individuals with BRCA2 gene mutations have up to a 7% lifetime risk for developing pancreatic cancer (PC). In addition, these mutations account for the highest percentage of inherited causes of PC. In 2012 the International Cancer of the Pancreas Screening (CAPS) Consortium developed statements on screening, surveillance and management of patients with increased risk for familial PC. Our aim was to describe longitudinal endoscopic ultrasound (EUS) findings in patients undergoing PC screening who harbor a mutation in BRCA2 and to correlate EUS and MRI/MRCP findings. Methods: Patients with BRCA2 mutations were identified through the University of Michigan Breast and Ovarian Cancer Risk Evaluation Program Registry. Demographic information and descriptive analysis of screening tests were obtained from a prospective cohort. Results: 91 patients with BRCA2 mutations were enrolled in the registry, of which 37 (40.7%) were referred for PC screening discussion. Patients were followed for a mean of 7.5 years (+4). Demographic and clinical characteristics were similar between those who were and were not sent for PC screening (mean age 55.2±12.2y v. 54.5±11.5y; mean BMI 29.3±7.3 v. 25.8±5.5). Patients with a family history of PC (OR 9.5, 95% CI 1.1-82.5) were most likely to be referred for PC screening discussion. Of those referred, 18 (48.6%) BRCA2 mutation carriers pursued PC screening. All had EUS performed with 9 (50%) having both EUS and MRI. An average of 2.52 EUS and 1.75 MRI exams were performed. A normal exam on EUS or MRI was present in 12 (66.7%) and 7 (77.8%) patients, respectively. No solid lesions were identified on any surveillance exam. Two patients (11.1%) had a cystic lesion identified on initial EUS consistent with branch-duct (BD) IPMN. An additional 2 patients (11.1%) developed cystic lesions consistent with BD-IPMN after an average of 5 years. Other EUS findings included diffuse echogenicity suggestive of fatty infiltration of the pancreas in 2 (11.1%) patients and changes indeterminate or suggestive of chronic pancreatitis based on Rosemont criteria in 3 (16.7%) patients. Conclusion: In individuals with BRCA2 mutations, less than ½ pursued PC screening. The majority of patients were found to have normal screening examinations. Overtime, 22.2% of patients had findings consistent with BD-IPMNs. Further studies should be performed to determine appropriate screening recommendations and intervals.

The role of Endoscopic Ultrasound (EUS) in the management of patients with pancreatic cancer: now bigger than ever.

In this issue of the Journal of Gastrointestinal Oncology De Angelis et al. provide a comprehensive review of the role of endoscopic ultrasound (EUS) in the management of pancreatic cancer. At present the two main established roles of EUS are imaging and tissue acquisition. In addition some EUS-guided therapieshave gained limited but expanding role in pancreatic cancer patients. As correctly pointed by the authors, the role of standard EUS imaging for diagnosis and staging has decreased with the advent of dynamic contrast enhanced multi-detector row computed tomography (MDCT). Nevertheless, contrary to the prevailing perceptions both EUS and MDCT are operator dependent and significant variability of image quality and interpretations exist with MDCT. Furthermore, EUS remains superior imaging modality to detect small pancreatic lesions, mural nodules within a cyst, small lymph nodes and coexisting biliary pathology. We concur with the authors that inmost patients EUS and MDCT should be considered complimentary rather than competing imaging modalities for the evaluation of patients with suspected pancreatic lesions with MDCT been the initial test in most patients. Anotable exception is the screening of populations at high risk for pancreatic cancer where the recent International Cancer of the Pancreas Screening (CAPS) Consortium summit endorsed EUS as the initial test of choice (1,2). EUS is also preferably used for serial surveillance of premalignant pancreatic lesions [e.g., Intraductal papillary mucinous neoplasm (IPMN)] without the radiation exposure associated with MDCT (3). The addition of contrast-enhanced EUS and elastography may expand the utility of EUS imaging for solid pancreatic masses but their role is yet to be determined (4,5). Furthermore, early data on EUS-guided needle based confocal laser endomicroscopy (nCLE) have shown promising results in the evaluation of pancreatic cysts (6,7). On the contrary, EUS with fine needle aspiration (EUS-FNA) has refused to share the scene with other sampling modalities and has become the preferred method for tissue acquisition in patients with pancreatic lesions. EUS may not be necessary in all pancreatic cancer cases but pretreatment pathological diagnosis is essential in most patients with both resectable and advanced disease. Recently the role of EUS sampling has expanded further with the introduction of a new needle with core trap that can provide histologic samples also refereed as fine needle biopsy (EUS-FNB) (8). This is an exciting development because EUS-FNB can facilitate accurate tissue diagnosis in situations where FNA cytology has been known to be inadequate (e.g., autoimmune pancreatitis, lymphoma) but also can provide assessment for tumor vascular and lymphatic invasion. Furthermore, in the forceable future treatment decisions and patient prognosis most likely will be based on molecular markers and EUS appears to be the ideal tool to gather adequate tissue for analysis (9). EUS has also has expanded its role in selected patients with pancreatic cancer as a valuable therapeutic tool. At present, EUS-guided fiducial placement is now routinely done to facilitate image guided radiation therapy (10), EUS-guided celiac plexus neurolysis can greatly facilitate the management of pancreatic cancer pain (11), and EUS-guided biliary drainage is a viable alternative to percutaneous drainage in patient that had failed endoscopic retrograde cholangiopancreatography (ERCP) or in patients with altered gastric anatomy (12). Importantly, in the future EUS most likely will play an important role in delivering novel local antitumor therapy. Ethanol ablation for selected small mucinous cyst has shown promising results and EUS fine needle injection (EUS-FNI) of various viral and biologic therapies has undergone preliminary evaluation (13). In conclusion, despitestiff competition from other imaging modalities standard EUS imaging remains a valuable tool. Contrast-enhanced EUS, EUS elastography and needle based confocal endomicroscopy may further expand the utility of EUS imaging but their exact role is yet to be determined. EUS-FNA is currently the preferred modality for tissue acquisition in patients with pancreatic lesions and the advent of FNB may further solidify this essential role. The therapeutic role of EUS has expanded and ranges from primary in the case of fiducial deployment to fall back strategy in the case of EUS-guided biliary drainage. In the forceable future, EUS-FNI most likely will play a central role for delivery of novel targeted antitumor medications but for now its role is limited to palliative celiac plexus neurolysis.

International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer

BackgroundScreening individuals at increased risk for pancreatic cancer (PC) detects early, potentially curable, pancreatic neoplasia.ObjectiveTo develop consortium statements on screening, surveillance and management of high-risk individuals with an inherited predisposition...