Frequent Detection of Pancreatic Lesions in Asymptomatic High-Risk Individuals

医学 无症状的 放射科 胰腺 胰管 磁共振成像 导管内乳头状粘液性肿瘤 胰腺癌 内科学 内镜超声 囊肿 发育不良 胃肠病学 癌症
作者
Marcia I. Canto,Ralph H. Hruban,Elliot K. Fishman,Ihab R. Kamel,Richard D. Schulick,Zhe Zhang,Mark Topazian,Naoki Takahashi,Joel G. Fletcher,Gloria M. Petersen,Alison P. Klein,Jennifer E. Axilbund,Constance A. Griffin,Sapna Syngal,John R. Saltzman,Koenraad J. Mortelé,Jeffrey Lee,Eric P. Tamm,Raghunandan Vikram,Priya Bhosale,Daniel Margolis,James J. Farrell,Michael Goggins
出处
期刊:Gastroenterology [Elsevier BV]
卷期号:142 (4): 796-804 被引量:596
标识
DOI:10.1053/j.gastro.2012.01.005
摘要

The risk of pancreatic cancer is increased in patients with a strong family history of pancreatic cancer or a predisposing germline mutation. Screening can detect curable, noninvasive pancreatic neoplasms, but the optimal imaging approach is not known. We determined the baseline prevalence and characteristics of pancreatic abnormalities using 3 imaging tests to screen asymptomatic, high-risk individuals (HRIs).We screened 225 asymptomatic adult HRIs at 5 academic US medical centers once, using computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasonography (EUS). We compared results in a blinded, independent fashion.Ninety-two of 216 HRIs (42%) were found to have at least 1 pancreatic mass (84 cystic, 3 solid) or a dilated pancreatic duct (n = 5) by any of the imaging modalities. Fifty-one of the 84 HRIs with a cyst (60.7%) had multiple lesions, typically small (mean, 0.55 cm; range, 2-39 mm), in multiple locations. The prevalence of pancreatic lesions increased with age; they were detected in 14% of subjects younger than 50 years old, 34% of subjects 50-59 years old, and 53% of subjects 60-69 years old (P < .0001). CT, MRI, and EUS detected a pancreatic abnormality in 11%, 33.3%, and 42.6% of the HRIs, respectively. Among these abnormalities, proven or suspected neoplasms were identified in 85 HRIs (82 intraductal papillary mucinous neoplasms and 3 pancreatic endocrine tumors). Three of 5 HRIs who underwent pancreatic resection had high-grade dysplasia in less than 3 cm intraductal papillary mucinous neoplasms and in multiple intraepithelial neoplasias.Screening of asymptomatic HRIs frequently detects small pancreatic cysts, including curable, noninvasive high-grade neoplasms. EUS and MRI detect pancreatic lesions better than CT.
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