Kasper A Overbeek1, Michael G Goggins2, Mohamad Dbouk3, Iris J M Levink4, Brechtje D M Koopmann4, Miguel Chuidian5, Ingrid C A W Konings4, Salvatore Paiella6, Julie Earl7, Paul Fockens8, Thomas M Gress9, Margreet G E M Ausems10, Jan-Werner Poley4, Nirav C Thosani11, Elizabeth Half12, Jesse Lachter12, Elena M Stoffel13, Richard S Kwon13, Alina Stoita14, Fay Kastrinos15, Aimee L Lucas16, Sapna Syngal17, Randall E Brand18, Amitabh Chak19, Alfredo Carrato20, Frank P Vleggaar21, Detlef K Bartsch22, Jeanin E van Hooft23, Djuna L Cahen4, Marcia Irene Canto5, Marco J Bruno4. 1. Department of Gastroenterology & Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands. Electronic address: k.overbeek@erasmusmc.nl. 2. Division of Gastroenterology, Johns Hopkins University School of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Baltimore, Maryland; Division of Pathology, Johns Hopkins University School of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Baltimore, Maryland; Division of Oncology, Johns Hopkins University School of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Baltimore, Maryland. 3. Division of Pathology, Johns Hopkins University School of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Baltimore, Maryland. 4. Department of Gastroenterology & Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands. 5. Division of Gastroenterology, Johns Hopkins University School of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Baltimore, Maryland. 6. General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy. 7. Department of Medical Oncology, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain; Biomedical Research Network in Cancer (CIBERONC), Madrid, Spain. 8. Department of Gastroenterology & Hepatology, Amsterdam Gastroenterology & Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. 9. Department of Gastroenterology, Endocrinology, Metabolism and Infectiology, Philipps University of Marburg, Marburg, Germany. 10. Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands. 11. Division of Gastroenterology, Hepatology and Nutrition, McGovern Medical School, UTHealth, Houston, Texas. 12. Department of Gastroenterology, Rambam Healthcare Campus, Haifa, Israel. 13. Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan. 14. Department of Gastroenterology, St Vincent's Hospital, Sydney, Darlinghurst, New South Wales, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia. 15. Division of Digestive and Liver Diseases, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York. 16. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York. 17. Population Sciences Division, Dana-Farber Cancer Institute, Division of Gastroenterology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. 18. Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 19. Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio. 20. Department of Medical Oncology, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain; Biomedical Research Network in Cancer (CIBERONC), Madrid, Spain; Department of Medicine and Medical Specialties, Medicine Faculty, Alcala University, Alcalá de Henares, Spain. 21. Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands. 22. Department of Visceral, Thoracic- and Vascular Surgery, Philipps University of Marburg, Marburg, Germany. 23. Department of Gastroenterology & Hepatology, Amsterdam Gastroenterology & Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, the Netherlands.
Abstract
BACKGROUND & AIMS: To successfully implement imaging-based pancreatic cancer (PC) surveillance, understanding the timeline and morphologic features of neoplastic progression is key. We aimed to investigate the progression to neoplasia from serial prediagnostic pancreatic imaging tests in high-risk individuals and identify factors associated with successful early detection. METHODS: We retrospectively examined the development of pancreatic abnormalities in high-risk individuals who were diagnosed with PC or underwent pancreatic surgery, or both, in 16 international surveillance programs. RESULTS: Of 2552 high-risk individuals under surveillance, 28 (1%) developed neoplastic progression to PC or high-grade dysplasia during a median follow-up of 29 months after baseline (interquartile range [IQR], 40 months). Of these, 13 of 28 (46%) presented with a new lesion (median size, 15 mm; range 7-57 mm), a median of 11 months (IQR, 8; range 3-17 months) after a prior examination, by which time 10 of 13 (77%) had progressed beyond the pancreas. The remaining 15 of 28 (54%) had neoplastic progression in a previously detected lesion (12 originally cystic, 2 indeterminate, 1 solid), and 11 (73%) had PC progressed beyond the pancreas. The 12 patients with cysts had been monitored for 21 months (IQR, 15 months) and had a median growth of 5 mm/y (IQR, 8 mm/y). Successful early detection (as high-grade dysplasia or PC confined to the pancreas) was associated with resection of cystic lesions (vs solid or indeterminate lesions (odds ratio, 5.388; 95% confidence interval, 1.525-19.029) and small lesions (odds ratio, 0.890/mm; 95% confidence interval 0.812-0.976/mm). CONCLUSIONS: In nearly half of high-risk individuals developing high-grade dysplasia or PC, no prior lesions are detected by imaging, yet they present at an advanced stage. Progression can occur before the next scheduled annual examination. More sensitive diagnostic tools or a different management strategy for rapidly growing cysts are needed.
BACKGROUND & AIMS: To successfully implement imaging-based pancreatic cancer (PC) surveillance, understanding the timeline and morphologic features of neoplastic progression is key. We aimed to investigate the progression to neoplasia from serial prediagnostic pancreatic imaging tests in high-risk individuals and identify factors associated with successful early detection. METHODS: We retrospectively examined the development of pancreatic abnormalities in high-risk individuals who were diagnosed with PC or underwent pancreatic surgery, or both, in 16 international surveillance programs. RESULTS: Of 2552 high-risk individuals under surveillance, 28 (1%) developed neoplastic progression to PC or high-grade dysplasia during a median follow-up of 29 months after baseline (interquartile range [IQR], 40 months). Of these, 13 of 28 (46%) presented with a new lesion (median size, 15 mm; range 7-57 mm), a median of 11 months (IQR, 8; range 3-17 months) after a prior examination, by which time 10 of 13 (77%) had progressed beyond the pancreas. The remaining 15 of 28 (54%) had neoplastic progression in a previously detected lesion (12 originally cystic, 2 indeterminate, 1 solid), and 11 (73%) had PC progressed beyond the pancreas. The 12 patients with cysts had been monitored for 21 months (IQR, 15 months) and had a median growth of 5 mm/y (IQR, 8 mm/y). Successful early detection (as high-grade dysplasia or PC confined to the pancreas) was associated with resection of cystic lesions (vs solid or indeterminate lesions (odds ratio, 5.388; 95% confidence interval, 1.525-19.029) and small lesions (odds ratio, 0.890/mm; 95% confidence interval 0.812-0.976/mm). CONCLUSIONS: In nearly half of high-risk individuals developing high-grade dysplasia or PC, no prior lesions are detected by imaging, yet they present at an advanced stage. Progression can occur before the next scheduled annual examination. More sensitive diagnostic tools or a different management strategy for rapidly growing cysts are needed.
Authors: Mohamad Dbouk; Bryson W Katona; Randall E Brand; Amitabh Chak; Sapna Syngal; James J Farrell; Fay Kastrinos; Elena M Stoffel; Amanda L Blackford; Anil K Rustgi; Beth Dudley; Linda S Lee; Ankit Chhoda; Richard Kwon; Gregory G Ginsberg; Alison P Klein; Ihab Kamel; Ralph H Hruban; Jin He; Eun Ji Shin; Anne Marie Lennon; Marcia Irene Canto; Michael Goggins Journal: J Clin Oncol Date: 2022-06-15 Impact factor: 50.717