1. Timeline of Development of Pancreatic Cancer and Implications for Successful Early Detection in High-Risk Individuals
- Author
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Overbeek, K.A., Goggins, M.G., Dbouk, M., Levink, I.J.M., Koopmann, B.D.M., Chuidian, M., Konings, I.C.A.W., Paiella, S., Earl, J., Fockens, P., Gress, T.M., Ausems, M.G.E.M., Poley, J.W., Thosani, N.C., Half, E., Lachter, J., Stoffel, E.M., Kwon, R.S., Stoita, A., Kastrinos, F., Lucas, A.L., Syngal, S., Brand, R.E., Chak, A., Carrato, A., Vleggaar, F.P., Bartsch, D.K., Hooft, J.E. van, Cahen, D.L., Canto, M.I., Bruno, M.J., Int Canc Pancreas Screening Consor, Gastroenterology and hepatology, Gastroenterology and Hepatology, CCA - Cancer Treatment and Quality of Life, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, and Gastroenterology & Hepatology
- Subjects
medicine.medical_specialty ,Surveillance ,Hepatology ,Intraductal papillary mucinous neoplasm ,medicine.diagnostic_test ,business.industry ,Familial Pancreatic Cancer ,Gastroenterology ,Pancreatic Intraepithelial Neoplasia ,medicine.disease ,Lesion ,Pancreatic Cancer ,medicine.anatomical_structure ,Fine-needle aspiration ,SDG 3 - Good Health and Well-being ,Dysplasia ,Interquartile range ,Pancreatic cancer ,medicine ,Screening ,Radiology ,medicine.symptom ,Pancreas ,business - 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.
- Published
- 2022
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