Detection Of Early Neoplastic Lesions Research Articles

Optical enhancement mode 2 improves the detection rate of gastric neoplastic lesion in high-risk populations: A multicenter randomized controlled clinical study.

Detection of early neoplastic lesions is crucial for improving the survival rates of patients with gastric cancer. Optical enhancement mode 2 is a new image-enhanced endoscopic technique that offers bright images and can improve the visibility of neoplastic lesions. This study aimed to compare the detection of neoplastic lesions with optical enhancement mode 2 and white-light imaging (WLI) in a high-risk population. In this prospective multicenter randomized controlled trial, patients were randomly assigned to optical enhancement mode 2 or WLI groups. Detection of suspicious neoplastic lesions during the examinations was recorded, and pathological diagnoses served as the gold standard. A total of 1211 and 1219 individuals were included in the optical enhancement mode 2 and WLI groups, respectively. The detection rate of neoplastic lesions was significantly higher in the optical enhancement mode 2 group (5.1% vs. 1.9%; risk ratio, 2.656 [95% confidence interval, 1.630-4.330]; p<0.001). The detection rate of neoplastic lesions with an atrophic gastritis background was significantly higher in the optical enhancement mode 2 group (8.6% vs. 2.6%, p<0.001). The optical enhancementmode2 group also had a higher detection rate among endoscopists with different experiences. Optical enhancement mode 2 was more effective than WLI for detecting neoplastic lesions in the stomach, and can serve as a new method for screening early gastric cancer in clinical practice. United States National Library of Medicine (https://www. gov), ID: NCT040720521.

Occurrence of Colorectal Cancer After a Negative Colonoscopy in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis.

Despite the application of colorectal cancer (CRC) surveillance guidelines, the detection of early neoplastic lesions might be difficult in patients with inflammatory bowel disease (IBD). To explore the risk of post-colonoscopy CRC (PCCRC) in patients with IBD we performed a systematic review and meta-analysis. A systematic literature search was performed (PROSPERO; no. CRD42023453049). We included studies reporting the 3-year PCCRC (PCCRC-3y) prevalence, according to World Endoscopy Organization (WEO)-endorsed definition, in IBD and non-IBD patients. As primary outcome we evaluated the PCCRC-3y prevalence, according to WEO definitions, in IBD- and non-IBD patients and calculated the odds ratio (OR). The secondary outcome was to assess risk factors for PCCRC development in IBD patients. Three retrospective observational cohort studies were included. The pooled PCCRC-3y rate in patients with IBD was 30.8% [95% confidence interval (CI)=24.4-37.5%] and in non-IBD patients was 6.8% (95%CI=6.2-7.4%). The PCCRC-3y occurrence in IBD patients was significantly higher than that in non-IBD patients (OR=6.04; 95%CI=4.04-9.4; I2=95%), but a high heterogeneity among studies was noted. Furthermore, patients with ulcerative colitis (UC) had a significantly higher prevalence of PCCRC than patients with Crohn's Disease (CD): 30.9% (95%CI=27.8-34.2%) vs. 22.3% (95%CI=18-27%), respectively (OR=1.6, 95%CI=1.2-2.2; I2=0%). One-third of CRC in IBD patients were PCCRC, and these numbers were significantly higher when compared with those in non-IBD patients. Furthermore, the prevalence of PCCRC in patients with UC was higher compared to those with CD. However, prospective studies are required to better characterize risk factors for PCCRC development in patients with IBD.

Rola lekarza rodzinnego i ginekologa w opiece nad kobietą

The risk of many gynecological diseases can be remarkably reduced by making several changes in patients’ lifestyles. In this respect, emphasize the importance of family doctor care. Even if only through education on hygiene, proper diet, and physical activity. From the point of view of prevention and treatment, it is essential to understand the factors contributing to inflammation and oxidative stress in various diseases. Moreover, clinicians should know the patient’s body’s defense mechanisms. Undoubtedly, it is also crucial to ensure universal access to women’s reproductive health services, including in rural areas. The importance of early detection of neoplastic lesions at any age is emphasized, especially in genetically predisposed individuals with an increased risk of cancer. In this case, more frequent medical examinations are recommended from the patient’s childhood.

Surveillance Upper Endoscopy: Does Image Enhancement Method Affect Gastrointestinal Neoplasm Yield?

In endoscopic detection of early neoplastic lesions of the pharynx, esophagus, and stomach, lesions can be difficult to discern and challenging to

Dysplasia in Random Biopsies from Barrett's Surveillance Is an Important Marker for More Severe Pathology.

Although endoscopic recognition of dysplasia in Barrett's esophagus is difficult, experience in recognition of early neoplastic lesions is supposed to increase the detection of early neoplastic lesions. The aim of this study was to assess the significance of dysplasia in random biopsies in Barrett's esophagus, in the absence of reported visible lesions as well as the difference in final outcome of pathology. We retrospectively identified all patients with Barrett's esophagus with suspicion of dysplasia or early adenocarcinoma who were referred to our center between February 2008 and April 2016. We analyzed all endoscopy reports, pathology reports, and referral letters from 19 different hospitals. Patients were divided into two groups, based on the presence or absence of visible lesions reported upon referral. In total, 170 patients diagnosed with dysplasia or adenocarcinoma were referred to our tertiary center. Ninety-one of these referred patients were referred with dysplasia or adenocarcinoma in random biopsies, without a reported lesion during endoscopy in the referral center. During endoscopic work-up at our center, a visible lesion was detected in 44 of these 91 patients (48.4%). After endoscopic work-up and treatment, adenocarcinoma was found in an additional 21 patients. Two of these patients were initially referred with low-grade dysplasia, and 19 patients were initially referred with high-grade dysplasia. The final pathology was upstaged in 35.8% of the patients. The presence of any grade of dysplasia in random biopsies during surveillance in referral centers is a marker for more severe final pathology. Training in recognition of early neoplastic lesions in Barrett's esophagus imaging is recommended for endoscopists performing Barrett's surveillance.

Comparative evaluation of the diagnostic value of biopsy and NBI endoscopy in patients with cancer of the hypopharynx and larynx.

Novel endoscopic technique - Narrow Band Imaging (NBI) seems to be a promising method for an early detection of neoplastic lesions of the upper aerodigestive tract. Compared to white light endoscopy, NBI improves the visualisation of the mucosal and submucosal microvascular patterns of observed pathologies. The aim of the study was to evaluate the diagnostic value of biopsy and NBI in patients with cancer of the larynx and hypopharynx. The study was conducted in 100 adult subjects hospitalized in the Clinic of Otolaryngology, Laryngological Oncology, Audiology and Phoniatrics of Military Medical Academy University Teaching Hospital in Lodz, who were planned for surgical procedures for excision or surgical biopsy of pathological lesions of the hypopharynx or larynx. The following examinations were performed: subjective and objective, otorhinolaryngological, NBI endoscopy and histopathological assessment of suspicious lesions. The microvascular pattern of observed lesions was assessed according to the Ni scale criteria. The next stage of the study was to compare the endoscopic examination results (type of vascular pattern according to the Ni scale) with the histopathological result. The obtained results were subjected to statistical analysis. The sensitivity of NBI endoscopy in detection of malignant neoplasms in patients with hypopharynx and larynx lesions is 90.48%, specificity - 91.14%, positive predictive value - 73.08%, negative predictive value - 97.30%. C onclusions: NBI endoscopy is a modern imaging method, increasing the diagnostic potential of endoscopy in the early detection of malignant lesions within the hypopharynx and larynx.

Advanced Treatment and Imaging in Colonoscopy: The Pocket-Creation Method for Complete Resection and Linked Color Imaging for Better Detection of Early Neoplastic Lesions by Colonoscopy.

Early detection and resection of neoplastic lesions are key objectives to diminish colorectal cancer mortality. Resection of superficial colorectal neoplasms, cold snare polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection have all been developed and used worldwide. The pocket-creation method facilitates the resection of tumors in difficult and routine locations. Early detection is the most important first step to maximize the benefits of recent advancements in endoscopic techniques. However, the detection of small, flat-shaped, or faded color lesions remains difficult. Linked color imaging, a novel multi-light technology, facilitates the recognition of minor differences in tissue by enhancing the color contrast between early colorectal neoplasms and surrounding normal mucosa in a bright field of view. The most striking feature of linked color imaging is its ability to display the color of early neoplastic lesions as distinct from inflammatory changes, both of which have similar “redness” when viewed using white light imaging. To increase the detection rate of neoplasms, linked color imaging should be used from the outset for endoscopic observation. Early detection of superficial colorectal tumors can result in decreased mortality from colorectal cancer and maintain a good quality of life for patients.

Porphyrinoids in photodynamic diagnosis and therapy of oral diseases

Photodynamic methods have found application not only in the treatment process as photodynamic therapy but also for the early detection of neoplastic lesions and tumors as photodynamic diagnosis. Early detection of the disease allows not only to avoid the patient’s lifetime risk but also significantly reduce the costs of anticancer therapy, which are increasing every year. There is a constant search for new and more effective photosensitizers which will provide safety in therapy while maintaining efficiency. This paper summarizes recent reports focused on the photodynamic diagnosis of oral cancers. Moreover, it shows methods of the photodynamic treatment of oral verrucous hyperplasia, erythroleukoplakia, and oral leukoplakia. The treatment of choice for these diseases is a surgical excision, which always leads to scar formation. Photodynamic therapy provides a new scar-less tool for the treatment.

Familial Pancreatic Cancer and the Future of Directed Screening.

Pancreatic cancer (PC) is the third most common cause of cancer-related death in the United States and the 12th most common worldwide. Mortality is high, largely due to late stage of presentation and suboptimal treatment regimens. Approximately 10% of PC cases have a familial basis. The major genetic defect has yet to be identified but may be inherited by an autosomal dominant pattern with reduced penetrance. Several known hereditary syndromes or genes are associated with an increased risk of developing PC and account for approximately 2% of PCs. These syndromes include the hereditary breast-ovarian cancer syndrome, Peutz-Jeghers syndrome, familial atypical multiple mole melanoma, Lynch syndrome, familial polyposis, ataxia-telangiectasia, and hereditary pancreatitis. Appropriate screening using methods such as biomarkers or imaging, with endoscopic ultrasound and magnetic resonance imaging, may assist in the early detection of neoplastic lesions in the high-risk population. If these lesions are detected and treated before the development of invasive carcinoma, PC disease morbidity and mortality may be improved. This review will focus on familial PC and other hereditary syndromes implicated in the increased risk of PC; it will also highlight current screening methods and the future of new screening modalities.

French comment on article: Computer-aided detection of early neoplastic lesions in Barrett's esophagus.

French comment on article: Computer-aided detection of early neoplastic lesions in Barrett's esophagus.

Computer-aided detection of early neoplastic lesions in Barrett's esophagus.

Early neoplasia in Barrett's esophagus is difficult to detect and often overlooked during Barrett's surveillance. An automatic detection system could be beneficial, by assisting endoscopists with detection of early neoplastic lesions. The aim of this study was to assess the feasibility of a computer system to detect early neoplasia in Barrett's esophagus. Based on 100 images from 44 patients with Barrett's esophagus, a computer algorithm, which employed specific texture, color filters, and machine learning, was developed for the detection of early neoplastic lesions in Barrett's esophagus. The evaluation by one endoscopist, who extensively imaged and endoscopically removed all early neoplastic lesions and was not blinded to the histological outcome, was considered the gold standard. For external validation, four international experts in Barrett's neoplasia, who were blinded to the pathology results, reviewed all images. The system identified early neoplastic lesions on a per-image analysis with a sensitivity and specificity of 0.83. At the patient level, the system achieved a sensitivity and specificity of 0.86 and 0.87, respectively. A trade-off between the two performance metrics could be made by varying the percentage of training samples that showed neoplastic tissue. The automated computer algorithm developed in this study was able to identify early neoplastic lesions with reasonable accuracy, suggesting that automated detection of early neoplasia in Barrett's esophagus is feasible. Further research is required to improve the accuracy of the system and prepare it for real-time operation, before it can be applied in clinical practice.

Swept Source Optical Coherence Tomography Endomicroscope Based on Vertically Integrated Mirau Micro Interferometer: Concept and Technology

This paper presents a concept of an endomicroscope for an early detection of neoplastic lesions in the human stomach tissue, based on the swept source optical coherence tomography (SS-OCT) and a measurement probe with integrated Mirau micro interferometer. The system consists of pigtailed illumination and detection blocks, connected via a Gradient Index (GRIN) lens collimator to a micro-opto-electro-mechanical systems (MOEMS) measurement probe (4 mm × 4 mm × 20 mm). The technology of Mirau micro interferometer is based on vertical multi-wafer bonding approach. The MOEMS probe is intended to be mounted on a continuum robot arm to perform in vivo microscopy of stomach tissues. First, the optical design of the SS-OCT endomicroscope is described, including an analysis of sensitivity. Then, we focus on the fabrication technologies and optical characterization of a key component of the Mirau micro interferometer, i.e., monolithically integrated focusing glass lens. SS-OCT endomicroscope will provide a fast axial scanning of tissues with A-scan sweep rate of 110 kHz, offering the axial resolution of 5.2 μm and the lateral resolution of 10.2 μm.

White-Light or Narrow-Band Imaging Colonoscopy in Surveillance of Ulcerative Colitis: A Prospective Multicenter Study

Early detection of neoplastic lesions is essential in patients with long-standing ulcerative colitis but the best technique of colonoscopy still is controversial. We performed a prospective multicenter study in patients with long-standing ulcerative colitis. Two colonoscopies were performed in each patient within 3 weeks to 3 months. In white-light (WL) colonoscopy, stepwise random biopsy specimens (4 biopsy specimens every 10 cm), segmental random biopsies (2 biopsy specimens in 5 segments), and targeted biopsy specimens were taken. In NBI colonoscopy, segmental and targeted biopsy specimens were taken. The sequence of WL and NBI colonoscopy was randomized. In 36 of 159 patients enrolled (22.6%), 54 lesions with intraepithelial neoplasia (IN) were found (51 low-grade, 3 high-grade). In WL colonoscopy we found 11 IN in stepwise biopsy specimens, 4 in segmental biopsy specimens, and 15 in targeted biopsy specimens. In NBI colonoscopy 7 IN were detected in segmental biopsy specimens and 24 IN were detected in targeted biopsy specimens. Almost all IN were found with one technique alone (κ value of WL vs NBI, -0.86; P < .001). Statistically equivalent numbers of IN were found in NBI colonoscopy with targeted and segmental biopsy specimens as in WL colonoscopy with targeted and stepwise biopsy specimens, but with fewer biopsy specimens (11.9 vs 38.6 biopsy specimens, respectively; P < .001), and less withdrawal time was necessary (23 vs 13 min, respectively; P < .001). Stepwise biopsy specimens are indispensable in WL colonoscopy. The combination of targeted and segmental biopsy specimens in the NBI technique is as sensitive as targeted together with stepwise biopsy specimens in WL colonoscopy, but requires fewer biopsy specimens and less time. The highest sensitivity should be reached by combining the WL and NBI techniques by switching between the modes.

805 Computer-Aided Detection of Early Neoplastic Lesions in Barrett's Esophagus: Towards a Supportive Detection System in Endoscopy

unclear how dietary factors including increased fat intake may alter the composition of cellular membranes (both host and bacterial) and stool phospholipid profiles in both health and disease. Thus, we aimed to examine the lipid profile and microbial communities of stool samples from mice fed a control (10% calories from fat) or a high fat diet (HFD: 60% calories from fat) and after induction of colitis-associated tumors by AOM-DSS treatment. Phospholipids from stool were extracted and four classes of phospholipids were analyzed by triple quadrupole electrospray mass spectrometry (phosphotidylcholine, phosphotidylinositol, phosphotidylethanolamine, and phosphotidylserine). Peak masses were detected using MZmine 2.9 software and phospholipids identified using LipidMaps database. Microbiota was analyzed by automated ribosomal intergenic spacer analysis (ARISA) and qPCR for representative bacterial groups. Feeding a HFD did not significantly alter the total quantities of the phospholipids analyzed. However, tumor-bearing mice fed a control diet had significantly decreased total phosphotidylinositols compared to healthy control diet counterparts. Analysis of quantities of individual species of phospholipids revealed the greatest number of differences due to the presence of tumors rather than differences in diet as determined by partial-least squares discriminant analysis (PLS-DA) plotting. Our microbial analysis was consistent with previous studies in that we observed decreased quantities of Bacteroidetes and increased Firmicutes in animals fed a HFD. When we examined the presence or absence of identified microbial populations both diet and the presence of tumors were found to separate groups using principal component analysis (PCA). Consistent with the observation that phospholipid species were the most different between healthy and tumor bearing mice, the microbial communities also had the greatest variation based on this separation. Thus, we show that feeding a HFD and the presence of colitis-associated tumors alters both the stool phospholipid profile and the microbiota. Profiling the lipidome and the microbiome of stool in different dietary states will be an important area for future nutritional studies and may provide novel biomarkers to assess the health of both the host and its microbiota.

An unmet medical need: Advances in endoscopic imaging of colorectal neoplasia

Gastrointestinal cancer is a major public health problem worldwide. Detection of early neoplastic lesions in gastrointestinal tract is essential for cure, because prognosis and survival are related to the size and stage of malignant lesions. Endoscopic screening and treatment of polyps could prevent approximately 80% of colorectal cancer (CRC). However, white-light endoscopy is an imperfect technology since miss rates of up to 25% have been reported and polyps without malignant potential were treated without benefit but with additional costs and risks to the patient. There are several known "human" predictors of an inadequate colonoscopy. These include patient characteristics such as poor bowel preparation, female gender, or inpatient status. Skills of the endoscopists are also an important issue. Therefore, a variety of advanced technologies has been attempted to overcome these issues. These new endoscopic imaging techniques allow a more precise classification of mucosal alterations with selection of patients for invasive therapy or surveillance. Further, molecular and functional imaging techniques could identify novel targets for therapies and new prospects to access response to therapies. However, at the "end of the day" a better endoscopic approach for CRC screening and surveillance depends on a good bowel preparation, a trained endoscopist spending sufficient time on a detailed examination together with an advanced endoscope.

Characterizing variability in in vivo Raman spectra of different anatomical locations in the upper gastrointestinal tract toward cancer detection

Raman spectroscopy is an optical vibrational technology capable of probing biomolecular changes of tissue associated with cancer transformation. This study aimed to characterize in vivo Raman spectroscopic properties of tissues belonging to different anatomical regions in the upper gastrointestinal (GI) tract and explore the implications for early detection of neoplastic lesions during clinical gastroscopy. A novel fiber-optic Raman endoscopy technique was utilized for real-time in vivo tissue Raman measurements of normal esophageal (distal, middle, and proximal), gastric (antrum, body, and cardia) as well as cancerous esophagous and gastric tissues from 107 patients who underwent endoscopic examinations. The non-negativity-constrained least squares minimization coupled with a reference database of Raman active biochemicals (i.e., actin, histones, collagen, DNA, and triolein) was employed for semiquantitative biomolecular modeling of tissue constituents in the upper GI. A total of 1189 in vivo Raman spectra were acquired from different locations in the upper GI. The Raman spectra among the distal, middle, and proximal sites of the esophagus showed no significant interanatomical variability. The interanatomical variability of Raman spectra among normal gastric tissue (antrum, body, and cardia) was subtle compared to cancerous tissue transformation, whereas biomolecular modeling revealed significant differences between the two organs, particularly in the gastroesophageal junction associated with proteins, DNA, and lipids. Cancerous tissues can be identified across interanatomical regions with accuracies of 89.3% [sensitivity of 92.6% (162∕175); specificity of 88.6% (665∕751)], and of 94.7% [sensitivity of 90.9% (30∕33); specificity of 93.9% (216∕230)] in the gastric and esophagus, respectively, using partial least squares-discriminant analysis together with the leave-one tissue site-out, cross validation. This work demonstrates that Raman endoscopy technique has promising clinical potential for real-time, in vivo diagnosis and detection of malignancies in the upper GI at the molecular level.

Advanced endoscopic imaging in Barrett's esophagus

The goal of surveillance in Barrett's esophagus is the detection and treatment of early neoplasia. It has been shown that patients with early lesions (intraepithelial neoplasia or intramucosal cancer) can be cured with a high success rate. This is in contrast to advanced esophageal adenocarcinoma, which has a poor prognosis. Currently, many authorities regard endoscopic treatment for early neoplasia as equivalent, if not superior, to radical surgery because the cure rates are comparable with less mortality and morbidity. With the rising popularity of, and the expanding experience with, endoscopic treatment, principally endoscopic resection, precise localization of the neoplastic lesions within the Barrett's segment has become important for precise staging and successful resection. This localization results in low rates of residual and recurrent neoplasia. In recent years, many developments in the field of endoscopic imaging and treatment of Barrett's esophagus have greatly advanced the field. When it comes to endoscopic detection of early neoplastic lesions in Barrett's esophagus, the 21st century has brought several paradigm shifts.

Endoscopic work-up of early Barrett’s neoplasia

In recent years, endoscopic therapy of early Bar− rett’s esophagus neoplasia has become a safe and effective alternative to esophagectomy [1 ± 4]. Only patients with high−grade intraepithelial neoplasia (HGIN) or mucosal cancer are eligible for curative endoscopic treatment. Lesions that invade the submucosa are associated with a sig− nificant risk of lymph node metastases and are therefore preferably to be treated surgically. There are two main types of endoscopic therapy: endoscopic resection and endoscopic ablation. An important difference between these two modalities is that endoscopic resection permits histopathological evaluation of the resection spe− cimen, whereas this safeguard is missing with endoscopic ablation therapy. A practical ap− proach is to resect the areas with endoscopically visible lesions by endoscopic resection followed by ablation of residual Barrett’s esophagus [5± 8]. This assumes that if the histopathological evaluation of the most involved areas is favor− able, the chances that the residual Barrett’s esophagus harbors more advanced neoplasia elsewhere are small and thus additional ablation therapy without histological correlation is justi− fied. It is, therefore, crucial that the most in− volved area in the Barrett’s esophagus is indeed identified and resected rather than overlooked and ablated, since this may lead to undertreat− ment of submucosal lesions. In this review, we will discuss the endoscopic work−up for diagnosis and staging of early neo− plasia in Barrett’s esophagus (i. e., HGIN or muco− sal cancer), including the role of advanced ima− ging techniques and the importance of histopa− thological evaluation by endoscopic resection. Diagnosis ! Endoscopic detection of early neoplasia in Barrett’s esophagus The goal of endoscopic surveillance of patients with Barrett’s esophagus is the detection of early neoplastic lesions. To ensure the detection of ear− ly neoplastic lesions there are three rules that should be followed. These rules relate to the en− doscopic equipment used, the “detecting eye” of the endoscopist, and a systematic, meticulous approach.

New developments in the endoscopic surveillance of Barrett’s oesophagus

Patients with a Barrett’s oesophagus are at risk for developing an adenocarcinoma of the distal oesophagus. Therefore, many patients undergo endoscopic surveillance to detect dysplasia and/or cancer at an early...

Molecular Diagnosis of Early Pancreatic Ductal Adenocarcinoma in High-Risk Patients

The prevalence of pancreatic cancer in the general population is too low – even in high-prevalence areas such as Northern Europe and North America (8–12 per 10⁵ population) – relative to the diagnostic accuracy of present detection methods to permit primary screening in the asymptomatic adult population. The recognition that the lifetime risk of developing pancreatic cancer for patients with hereditary pancreatitis (HP) is extremely high (20% by the age of 60 years and 40% by the age of 70 years) poses considerable challenges and opportunities for secondary screening in those patients without any clinical features of pancreatic cancer. Even for secondary screening, the detection of cancer at a biological stage that would be amenable to cure by surgery (total pancreatectomy) still requires diagnostic modalities with a very high sensitivity and specificity. Conventional radiological imaging methods such as endoluminal ultrasound and endoscopic retrograde pancreatography, which have proved to be valuable in the early detection of early neoplastic lesions in patients with familial pancreatic cancer, may well be applicable to patients with HP but only in those without gross morphological features of chronic pancreatitis (other than parenchymal atrophy). Unfortunately, most cases of HP also have associated gross features of chronic pancreatitis that are likely to seriously undermine the diagnostic value of these conventional imaging modalities. Pre-malignant molecular changes can be detected in the pancreatic juice of patients. Thus, the application of molecular screening in patients with HP is potentially the most powerful method of detection of early pancreatic cancer. Although mutant (mt) K-ras can be detected in the pancreatic juice of most patients with pancreatic cancer, it is also present in patients with non-inherited chronic pancreatitis who do not progress to pancreatic cancer (at least in the short to medium term), as well as increasingly in the older population without pancreatic disease. Nevertheless, the presence of mt-K-ras may identify a genuinely higher-risk group, enabling additional diagnostic imaging and molecular resources to be focussed on such a group. What is clear is that prospective multi-centre studies, such as that being pursued by the European Registry of Hereditary Pancreatitis and Familial Pancreatic Cancer (EUROPAC), are essential for the development of an effective secondary screening programme for these patients.