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Meta-Analysis
. 2018 Jun;18(4):420-428.
doi: 10.1016/j.pan.2018.04.002. Epub 2018 Apr 10.

Screening/surveillance programs for pancreatic cancer in familial high-risk individuals: A systematic review and proportion meta-analysis of screening results

Salvatore Paiella  1 , Roberto Salvia  2 , Matteo De Pastena  2 , Tommaso Pollini  2 , Luca Casetti  2 , Luca Landoni  2 , Alessandro Esposito  2 , Giovanni Marchegiani  2 , Giuseppe Malleo  2 , Giulia De Marchi  3 , Aldo Scarpa  4 , Mirko D'Onofrio  5 , Riccardo De Robertis  6 , Teresa Lucia Pan  2 , Laura Maggino  2 , Stefano Andrianello  2 , Erica Secchettin  2 , Deborah Bonamini  2 , Davide Melisi  7 , Massimiliano Tuveri  2 , Claudio Bassi  2
Affiliations
Meta-Analysis

Screening/surveillance programs for pancreatic cancer in familial high-risk individuals: A systematic review and proportion meta-analysis of screening results

Salvatore Paiella et al. Pancreatology. 2018 Jun.

Abstract

Background/objectives: Screening/surveillance programs for pancreatic cancer (PC) in familial high-risk individuals (FPC-HRI) have been widely reported, but their merits remain unclear. The data reported so far are heterogeneous-especially in terms of screening yield. We performed a systematic review and meta-analysis of currently available data coming from screening/surveillance programs to evaluate the proportion of screening goal achievement (SGA), overall surgery and unnecessary surgery.

Methods: We searched MEDLINE, Embase, PubMed and the Cochrane Library database from January 2000 to December 2016to identify studies reporting results of screening/surveillance programs including cohorts of FPC-HRI. The main outcome measures were weighted proportion of SGA, overall surgery, and unnecessary surgery among the FPC-HRI cohort, using a random effects model. SGA was defined as any diagnosis of resectable PC, PanIN3, or high-grade dysplasia intraductal papillary mucinous neoplasm (HGD-IPMN). Unnecessary surgery was defined as any other final pathology.

Results: In a meta-analysis of 16 studies reporting on 1551 FPC-HRI cases, 30 subjects (1.82%), received a diagnosis of PC, PanIN3 or HGD-IPMNs. The pooled proportion of SGA was 1.4%(95% CI 0.8-2, p < 0.001, I2 = 0%). The pooled proportion of overall surgery was 6%(95% CI 4.1-7.9, p < 0.001, I2 = 60.91%). The pooled proportion of unnecessary surgery was 68.1%(95% CI 59.5-76.7, p < 0.001, I2 = 4.05%); 105 subjects (6.3%) received surgery, and the overall number of diagnoses from non-malignant specimens was 156 (1.5 lesion/subject).

Conclusions: The weighted proportion of SGA of screening/surveillance programs published thus far is excellent. However, the probability of receiving surgery during the screening/surveillance program is non-negligible, and unnecessary surgery is a potential negative outcome.

Keywords: Diagnostic yield; Familial pancreatic cancer; Pancreatic cancer; Screening program; Surveillance program.

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