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. 2022 Jun;71(6):1152-1160.
doi: 10.1136/gutjnl-2020-323611. Epub 2021 Apr 5.

Long-term yield of pancreatic cancer surveillance in high-risk individuals

Kasper A Overbeek  1 , Iris J M Levink  2 , Brechtje D M Koopmann  2 , Femme Harinck  2 , Ingrid C A W Konings  2 , Margreet G E M Ausems  3 , Anja Wagner  4 , Paul Fockens  5 , Casper H van Eijck  6 , Bas Groot Koerkamp  6 , Olivier R C Busch  7 , Marc G Besselink  7 , Barbara A J Bastiaansen  5 , Lydi M J W van Driel  2 , Nicole S Erler  8 , Frank P Vleggaar  9 , Jan-Werner Poley  2 , Djuna L Cahen  2 , Jeanin E van Hooft  5 , Marco J Bruno  2 ; Dutch Familial Pancreatic Cancer Surveillance Study Group
Collaborators, Affiliations

Long-term yield of pancreatic cancer surveillance in high-risk individuals

Kasper A Overbeek et al. Gut. 2022 Jun.

Abstract

Objective: We aimed to determine the long-term yield of pancreatic cancer surveillance in hereditary predisposed high-risk individuals.

Design: From 2006 to 2019, we 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 MRI/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 years, SD 9.9) were followed for 63 months on average (SD 43.2). Ten individuals developed PDAC, of which four presented with a symptomatic interval carcinoma and six 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 months (range 1-32). Surgery was performed in 17 individuals (4.6%), whose pathology revealed 6 PDACs (3 T1N0M0), 7 low-grade precursor lesions, 2 neuroendocrine tumours <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 PDAC was substantial in established high-risk mutation carriers, but non-existent in the mutation-negative proven FPC kindreds. Nevertheless, timely identification of resectable lesions proved challenging despite the concurrent use of two imaging modalities, with EUS outperforming MRI/MRCP. Overall, surveillance by imaging yields suboptimal results with a clear need for more sensitive diagnostic markers, including biomarkers.

Keywords: endoscopic ultrasonography; family cancer; magnetic resonance imaging; pancreatic cancer; surveillance.

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Conflict of interest statement

Competing interests: PF received research funding from Boston Scientific. He is a consultant to Olympus, Cook Medical and Ethicon Endosurgery. JWP is a consultant to Boston Scientific, Cook Medical and Pentax Medical. DLC is a consultant to Tramedico. JEH received research funding from Abbott and Cook Medical. She is a consultant to Boston Scientific, Cook Medical and Medtronics. MJB received research funding from Boston Scientific, Cook Medical and Pentax Medical. He is a consultant to Boston Scientific, Cook Medical, Pentax Medical and Mylan. The other authors have nothing to disclose.

Figures

Figure 1
Figure 1
Cumulative incidence of pancreatic cancer stratified for genetic risk category. FPC, familial pancreatic cancer.
See this image and copyright information in PMC

Comment in

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