Screening for pancreatic neoplasia in high-risk individuals: an EUS-based approach

Autor: Gloria M. Petersen, Kieran Brune, Sanjay B. Jagannath, Ralph H. Hruban, Francis M. Giardiello, Charles J. Yeo, Michael Goggins, Jennifer E. Axilbund, Steven Piantadosi, Syed Z. Ali, Marcia I. Canto, Constance A. Griffin, Elliot K. Fishman
Rok vydání: 2004
Předmět:
Male
Endoscopic ultrasound
medicine.medical_specialty
Pancreatic Intraepithelial Neoplasia
Malignancy
Risk Assessment
Gastroenterology
Statistics
Nonparametric
Endosonography
Age Distribution
Pancreatic cancer
Internal medicine
Prevalence
medicine
Humans
Mass Screening
Genetic Predisposition to Disease
Prospective Studies
Sex Distribution
Aged
Probability
Cholangiopancreatography
Endoscopic Retrograde
Endoscopic retrograde cholangiopancreatography
Hepatology
medicine.diagnostic_test
Intraductal papillary mucinous neoplasm
business.industry
Biopsy
Needle
Middle Aged
Prognosis
medicine.disease
Immunohistochemistry
digestive system diseases
Pedigree
Pancreatic Neoplasms
medicine.anatomical_structure
Feasibility Studies
Patient Compliance
Pancreatitis
Female
Radiology
Tomography
X-Ray Computed
Pancreas
business
Program Evaluation
Zdroj: Clinical Gastroenterology and Hepatology. 2:606-621
ISSN: 1542-3565
Popis: Background & Aims: Relatives of patients with pancreatic cancer and persons with certain inherited syndromes are at increased risk for developing pancreatic cancer. We prospectively evaluated the feasibility of screening for pancreatic neoplasia in high-risk individuals. Methods: Individuals from familial pancreatic cancer kindreds and a patient with Peutz-Jeghers syndrome underwent screening endoscopic ultrasound (EUS). If the EUS was abnormal, EUS-guided fine-needle aspiration, endoscopic retrograde cholangiopancreatography (ERCP), and spiral computed tomography (CT) were performed. Patients with abnormalities suggesting neoplasia had surgery. Results: Thirty-eight patients were studied; 31 (mean age, 58 yr; 42% men) from kindreds with ≥3 affected with pancreatic cancer; 6 from kindreds with 2 affected relatives, 1 was a patient with Peutz-Jeghers syndrome. None had symptoms referable to the pancreas or suggestive of malignancy. Six pancreatic masses were found by EUS: 1 invasive ductal adenocarcinoma, 1 benign intraductal papillary mucinous neoplasm, 2 serous cystadenomas, and 2 nonneoplastic masses. Hence, the diagnostic yield for detecting clinically significant pancreatic neoplasms was 5.3% (2 of 38). The 1 patient with pancreatic cancer was treated and still is alive and disease-free >5 years after surgery. EUS changes similar to those associated with chronic pancreatitis were found, which were more common in patients with a history of regular alcohol intake ( P = 0.02), but also occurred in patients who did not consume alcohol. Screening also led to a new diagnosis and treatment of symptomatic upper-gastrointestinal conditions in 18.4% of patients. Conclusions: EUS-based screening of asymptomatic high-risk individuals can detect prevalent resectable pancreatic neoplasia but false-positive diagnoses also occur.
Databáze: OpenAIRE
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