Diagnostic Yield From Screening Asymptomatic Individuals at High Risk for Pancreatic Cancer: A Meta-analysis of Cohort Studies
Open accessAbstract
Background & aims There have been few studies of abdominal imaging screening of individuals at high risk for pancreatic cancer (based on family history or genetic variants). We performed a meta-analysis of prospective cohort studies to determine the diagnostic yield and outcomes of abdominal imaging screening for asymptomatic individuals at high risk.Methods Through a systematic review of multiple electronic databases and conference proceedings through July 2017, we identified prospective cohort studies (>20 patients) of asymptomatic adults determined to be at high-risk of pancreatic cancer (lifetime risk >5%, including specific genetic-associated conditions) who were screened by endoscopic ultrasound (EUS) and/or magnetic resonance imaging (MRI) to detect pancreatic lesions. Our primary outcome was identification of high-risk pancreatic lesions (high-grade pancreatic intraepithelial neoplasia, high-grade dysplasia, or adenocarcinoma) at initial screening, and overall incidence during follow up. Summary estimates were reported as incidence rates per 100 patient-years.Results We identified 19 studies comprising 7085 individuals at high risk for pancreatic cancer; of these, 1660 patients were evaluated by EUS and/or MRI. Fifty-nine high-risk lesions were identified (43 adenocarcinomas: 28 during the initial exam and 15 during follow-up surveillance) and 257 patients underwent pancreatic surgery. Based on our meta-analysis, the overall diagnostic yield screening for high-risk pancreatic lesions was 0.74 (95% CI, 0.33-1.14), with moderate heterogeneity among studies. The number needed to screen to identify 1 patient with a high-risk lesion was 135 (95% CI, 88-303). The diagnostic yield was similar for patients with different genetic features that increased risk, and whether patients were screened by EUS or MRI.Conclusions Based on meta-analysis, 135 patients at high-risk for pancreatic cancer must be screened to identify 1 patient with a high-risk pancreatic lesion. Further studies are needed to determine whether screening reduces mortality and is cost effectiveness for individuals at high-risk of pancreatic cancer.
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The five CAPS5 pancreatic resections for worrisome findings that harbored low-grade dysplasia only represent a smaller proportion of resections for low-grade lesions than reported in prior studies, likely due to better selection of patients for surgery.
“it is notable that these five cases represent a smaller proportion of resections for low-grade lesions than has been reported in prior studies14,15,29,30 and likely results from better selection of patients for surgery.”
From The Multicenter Cancer of Pancreas Screening Study: Impact on Stage and Survival (2022) · cites this paper as [15]
Recent evidence indicates that pancreas surveillance can downstage pancreatic cancers diagnosed in high-risk individuals, though based on few studies.
“Recent evidence indicates that pancreas surveillance can downstage pancreatic cancers diagnosed in high-risk individuals (HRIs), although this is based upon only a few studies,12,14-16 with relatively few PDACs diagnosed, and only a small percentage of which were diagnosed with stage I disease.17”
From The Multicenter Cancer of Pancreas Screening Study: Impact on Stage and Survival (2022) · cites this paper as [15]
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- Authors
- Corral, J. E., Mareth, K. F., Riegert-Johnson, D. L., Das, A., & Wallace, M. B.
- Affiliations
- Mayo Clinic (US)
- St. Joseph's Hospital and Medical Center (US)
- Corresponding author
- Wallace, Michael B.
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2019-01
- Volume
- 17
- Issue
- 1
- Pages
- 41-53
- ISSN
- 1542-3565 (ISSN-L)
- OpenAlex
- W2809523459
- Cited by
- 113
- References
- 49
- Citations by year
- 2026: 12 · 2025: 9 · 2024: 13 · 2023: 19 · 2022: 14 · 2021: 16 · 2020: 14 · 2019: 10 · 2018: 6
- FWCI
- 1.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Surgery › Pancreatitis Pathology and Treatment
- Keywords
- pancreatic cancer screening, high-risk individuals, endoscopic ultrasound, magnetic resonance imaging, diagnostic yield, pancreatic intraepithelial neoplasia, pancreatic ductal adenocarcinoma, pancreatic dysplasia, genetic susceptibility, family history (medicine), surveillance (medicine), number needed to screen
- MeSH terms
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Pancreatic Neoplasms, Incidence, Early Detection of Cancer, Young Adult, Asymptomatic Diseases, Optical Imaging
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