Frequent detection of pancreatic lesions in asymptomatic high-risk individuals
Open accessAbstract
Background & aims The risk of pancreatic cancer is increased in patients with a strong family history of pancreatic cancer or a predisposing germline mutation. Screening can detect curable, noninvasive pancreatic neoplasms, but the optimal imaging approach is not known. We determined the baseline prevalence and characteristics of pancreatic abnormalities using 3 imaging tests to screen asymptomatic, high-risk individuals (HRIs).Methods We screened 225 asymptomatic adult HRIs at 5 academic US medical centers once, using computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasonography (EUS). We compared results in a blinded, independent fashion.Results Ninety-two of 216 HRIs (42%) were found to have at least 1 pancreatic mass (84 cystic, 3 solid) or a dilated pancreatic duct (n = 5) by any of the imaging modalities. Fifty-one of the 84 HRIs with a cyst (60.7%) had multiple lesions, typically small (mean, 0.55 cm; range, 2-39 mm), in multiple locations. The prevalence of pancreatic lesions increased with age; they were detected in 14% of subjects younger than 50 years old, 34% of subjects 50-59 years old, and 53% of subjects 60-69 years old (P < .0001). CT, MRI, and EUS detected a pancreatic abnormality in 11%, 33.3%, and 42.6% of the HRIs, respectively. Among these abnormalities, proven or suspected neoplasms were identified in 85 HRIs (82 intraductal papillary mucinous neoplasms and 3 pancreatic endocrine tumors). Three of 5 HRIs who underwent pancreatic resection had high-grade dysplasia in less than 3 cm intraductal papillary mucinous neoplasms and in multiple intraepithelial neoplasias.Conclusions Screening of asymptomatic HRIs frequently detects small pancreatic cysts, including curable, noninvasive high-grade neoplasms. EUS and MRI detect pancreatic lesions better than CT.
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MRI is better for pancreatic cyst detection, and EUS is better for solid lesions.
“The question of what imaging modality to use was addressed in part by a comparative study by the Rotterdam group showing that MRI was better for pancreatic cyst detection, and EUS was better for solid lesions.74”
From Artificial Intelligence and Early Detection of Pancreatic Cancer: 2020 Summative Review (2021) · cites this paper as [74]
The Results (Concordance of CT, MRI, and EUS Pancreatic Abnormalities; page unavailable) support the EUS portion: EUS detected three solid nodules missed by MRI. They do not support MRI being better for cyst detection: EUS detected slightly more subcentimeter cysts and more cysts over 1 cm. The Methods describe screening at five US medical centers, not a Rotterdam-group study. (LLM, conf=0.86)
Experimental — accuracy not yet measuredEUS and MRI have higher comparable diagnostic yield in a 3-way blinded comparison of EUS, MRI, and CT.
“A 3-way blinded comparison of EUS, MRI, and CT also showed that EUS and MRI had higher comparable diagnostic yield.75”
From Artificial Intelligence and Early Detection of Pancreatic Cancer: 2020 Summative Review (2021) · cites this paper as [75]
The preference for EUS and MRI/MRCP over CT is based on their superiority at detecting subcentimetre pancreatic cysts and on avoiding ionising radiation.
“The preference for EUS and MRI/MRCP rather than CT is based on their superiority at detecting subcentimetre pancreatic cysts, and avoidance of ionising radiation.”
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Self-citation
- Authors
- Canto, M. I., Hruban, R. H., Fishman, E. K., Kamel, I. R., Schulick, R., Zhang, Z., Topazian, M., Takahashi, N., Fletcher, J., Petersen, G., Klein, A. P., Axilbund, J., Griffin, C., Syngal, S., Saltzman, J. R., Mortele, K. J., Lee, J., Tamm, E., Vikram, R., Bhosale, P., Margolis, D., Farrell, J., & Goggins, M.
- Affiliations
- Johns Hopkins University (US)
- Mayo Clinic (US)
- Brigham and Women's Hospital (US)
- The University of Texas MD Anderson Cancer Center (US)
- University of California, Los Angeles (US)
- Corresponding author
- Canto, Marcia Irene
- ORCID
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2012-04
- Volume
- 142
- Issue
- 4
- Pages
- 796-804
- ISSN
- 0016-5085 (ISSN-L)
- PMC
- PMC3321068
- OpenAlex
- W2055276888
- Cited by
- 648
- References
- 38
- Citations by year
- 2026: 21 · 2025: 22 · 2024: 42 · 2023: 42 · 2022: 39 · 2021: 47 · 2020: 37 · 2019: 52 · 2018: 55 · 2017: 65 · 2016: 54 · 2015: 63 · 2014: 39 · 2013: 43 · 2012: 27
- FWCI
- 27.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (P50 CA62924)
- Lustgarten Foundation
- Olympus
- Topics
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Health Sciences › Medicine › Surgery › Pancreatitis Pathology and Treatment
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- pancreatic cancer screening, high-risk individuals, pancreatic cysts, intraductal papillary mucinous neoplasm, pancreatic neuroendocrine tumors, pancreatic duct dilatation, endoscopic ultrasound, magnetic resonance imaging, computed tomography, pancreatic neoplasms, familial pancreatic cancer, germline mutations, intraepithelial neoplasia, pancreatic resection
- MeSH terms
- Academic Medical Centers, Aged, Diagnostic Imaging, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Pancreatic Cyst, Pancreatic Neoplasms, Pedigree, Predictive Value of Tests, Prognosis, Prospective Studies, Risk Factors, Tomography, X-Ray Computed, United States, Prevalence, Multivariate Analysis, Chi-Square Distribution, Logistic Models, Risk Assessment, Endosonography, Genetic Predisposition to Disease, Heredity, Asymptomatic Diseases
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