TY - JOUR
T1 - Timeline of Development of Pancreatic Cancer and Implications for Successful Early Detection in High-Risk Individuals
AU - International Cancer of the Pancreas Screening Consortium
AU - Overbeek, Kasper A.
AU - Goggins, Michael G.
AU - Dbouk, Mohamad
AU - Levink, Iris J.M.
AU - Koopmann, Brechtje D.M.
AU - Chuidian, Miguel
AU - Konings, Ingrid C.A.W.
AU - Paiella, Salvatore
AU - Earl, Julie
AU - Fockens, Paul
AU - Gress, Thomas M.
AU - Ausems, Margreet G.E.M.
AU - Poley, Jan Werner
AU - Thosani, Nirav C.
AU - Half, Elizabeth
AU - Lachter, Jesse
AU - Stoffel, Elena M.
AU - Kwon, Richard S.
AU - Stoita, Alina
AU - Kastrinos, Fay
AU - Lucas, Aimee L.
AU - Syngal, Sapna
AU - Brand, Randall E.
AU - Chak, Amitabh
AU - Carrato, Alfredo
AU - Vleggaar, Frank P.
AU - Bartsch, Detlef K.
AU - van Hooft, Jeanin E.
AU - Cahen, Djuna L.
AU - Canto, Marcia Irene
AU - Bruno, Marco J.
N1 - Publisher Copyright:
© 2022 The Authors
PY - 2022/3
Y1 - 2022/3
N2 - 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.
AB - 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.
KW - Familial Pancreatic Cancer
KW - Pancreatic Cancer
KW - Screening
KW - Surveillance
UR - http://www.scopus.com/inward/record.url?scp=85124581308&partnerID=8YFLogxK
U2 - 10.1053/j.gastro.2021.10.014
DO - 10.1053/j.gastro.2021.10.014
M3 - Article
C2 - 34678218
AN - SCOPUS:85124581308
SN - 0016-5085
VL - 162
SP - 772-785.e4
JO - Gastroenterology
JF - Gastroenterology
IS - 3
ER -