Early detection for pancreatic cancer in individuals at elevated-risk, using endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI) of the abdomen: Feasibility and preliminary outcomes.

Abstract

e16798 Background: There are no accepted guidelines for testing individuals at elevated risk for developing pancreatic duct adenocarcinoma (PC). We initiated a prospective screening and surveillance program for individuals at elevated risk for PC. Methods: Eligibility for the Pancreatic Cancer Early Detection Protocol (PCEDP) was based on germ line status and/or family history of PC, provided that the imparted risk was either five times that of the general population or 7.5% lifetime risk for developing PC. Testing was continued alternating between Endoscopic Ultrasound (EUS) and Magnetic Resonance Imaging (MRI) of the abdomen. Objectives were was to analyze the number, type, and location of pancreatic conditions found and their associations with genetic or family history; and to evaluate the outcomes and/or complications that may have resulted from our testing. Results: From April 2014 through October 2019 we received 238 queries, out of which 75 individuals (31%) enrolled in the PCEDP. Eligibility was based upon individual’s germ line only (45%), family history only (32%), and both (23%). Germ line mutations were observed in 34 (BRCA2), 9 (BRCA1), 4 (ATM), 3 (PALB2), and 3 (CDKN2A) individuals. Median age at consent was 57, 60% were female,and88%, 4%, 3%, and 1% self-identified as Caucasian, African American, Hispanic, and Asian, respectively. 133 EUS procedures and 83 MRIs have been performed. No serious adverse events occurred. Standard Insurance approved and paid for the vast majority of tests. Four individuals withdrew (5%) and three (4%) were lost to follow up. Ten individuals (13%) were found to have abnormal findings in the pancreas and therefore met an endpoint of the study, including seven anechoic cysts and three suspected intraductal papillary mucinous neoplasms (IPMN). All individuals with endpoints were recommended to continue surveillance with EUS. Eight of the ten endpoints were found on baseline EUS, one one from baseline MRI, and one was found on the 3rd EUS. One of the individuals with a 2.5cm IPMN seen on baseline EUS underwent a subsequent distal pancreatectomy, with pathology revealing high grade dysplasia. Conclusions: Screening and surveillance for PC using EUS alternating with MRI was feasible and well tolerated in our population of individuals with an elevated risk. Baseline EUS was successful in detecting 10/75 = 13% of enrollees with some abnormal pancreatic finding, including one requiring intervention with a high grade pre-malignant IPMN.

New-onset Diabetes as a Signpost of Early Pancreatic Cancer: The Role of Screening

“…18 Preliminary results from another ongoing Pancreatic Cancer Early Detection Program (PCEDP) study 19 show screening for pancreatic cancer in high-risk patients (7.5% lifetime risk) with alternating MRI and EUS is feasible and well-tolerated. 20 These data and other studies suggest that screening/surveillance programs for high-risk patients with familial risk/genetic predisposition are effective. 21,22 Several other prospective clinical trials are ongoing to further elucidate the utility of screening for pancreatic cancer among patients with high-risk family history or germline mutations.…”

Clinical features of patients with pancreatic ductal adenocarcinoma with a history of other primary malignancies: A retrospective analysis

“…PDAC is still considered a poor prognostic disease, despite developments in diagnosis and treatment ( 1 , 2 ). To overcome such difficulties, early diagnosis, especially for identifying suitable patients for therapeutic intervention, is important ( 2 , 7 ). Moreover, recent advances in cancer medicine, especially in the genetic aspect, have provided new therapeutic and diagnostic modalities for specific populations of patients with PDAC ( 8-10 ).…”

“…To overcome such difficulties, multidisciplinary therapeutic approaches, including surgical treatment, chemotherapy, and radiotherapy, have recently been reported, with improvements in prognosis (3)(4)(5)(6). Prompt and accurate diagnoses of patients suitable for the aforementioned therapeutic approaches are important (2,7). Recently, PDAC arising from genetic abnormalities, such as familial pancreatic cancer, hereditary breast and ovarian cancer syndrome, Lynch syndrome, and Peutz-Jeghers syndrome, has been analyzed and reported as a representative example of such backgrounds (8)(9)(10).…”