Pancreas
Gut. 2022;71(6):1152–60
Long-term yield of pancreatic cancer surveillance in high-risk individuals
Objective: The authors aimed to determine the long-term yield of pancreatic cancer surveillance in hereditary predisposed high-risk individuals.
Design: From 2006 to 2019, they prospectively enrolled asymptomatic individuals with an estimated 10% or greater lifetime risk of pancreatic ductal adenocarcinoma (PDAC) after obligatory evaluation by a clinical geneticist and genetic testing, and subjected them to annual surveillance with both endoscopic ultrasonography (EUS) and magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) at each visit.
Results: 366 individuals (201 mutation-negative familial pancreatic cancer [FPC] kindreds and 165 PDAC susceptibility gene mutation carriers; mean age 54 ± 9.9 years) were followed for 63 ± 43.2 months on average. Ten individuals developed PDAC, of which 4 presented with a symptomatic interval carcinoma and 6 underwent resection. The cumulative PDAC incidence was 9.3% in the mutation carriers and 0% in the FPC kindreds (p < 0.001). Median PDAC survival was 18 (range, 1–32) months. Surgery was performed in 17 individuals (4.6%), whose pathology revealed 6 PDACs (3 T1N0M0), 7 low-grade precursor lesions, 2 neuroendocrine tumors < 2 cm, 1 autoimmune pancreatitis and in 1 individual no abnormality. There was no surgery-related mortality. EUS detected more solid lesions than MRI/MRCP (100% vs. 22%, p < 0.001), but less cystic lesions (42% vs. 83%, p < 0.001).
Conclusion: The diagnostic yield of pancreatic ductal adenocarcinoma was substantial in established high-risk mutation carriers, but non-existent in the mutation-negative proven familial pancreatic cancer kindreds. Nevertheless, timely identification of resectable lesions proved challenging despite the concurrent use of 2 imaging modalities, with endoscopic ultrasound outperforming magnetic resonance imaging/magnetic resonance cholangiopancreatography. Overall, surveillance by imaging yields suboptimal results with a clear need for more sensitive diagnostic markers, including biomarkers.