Development of a High Risk Pancreatic Screening Clinic Using 3.0 T MRI

Overview

Journal Fam Cancer

Publisher Springer

Specialty Oncology

Date 2017 Nov 5

PMID 29101607

Citations 11

Authors

Chad A Barnes

Elizabeth Krzywda

Shannon Lahiff

Dena McDowell

Kathleen K Christians

Paul Knechtges

Parag Tolat

Mark Hohenwalter

Kulwinder Dua

Abdul H Khan

Douglas B Evans

Jennifer Geurts

Susan Tsai

Affiliations

Soon will be listed here.

Abstract

Selective screening for pancreatic cancer (PC) has been proposed. We describe the establishment of a comprehensive multidisciplinary screening program using 3.0 T MRI. Criteria for screening included the presence of PC in: ≥ 2 first degree relatives (FDR), 1 FDR and 1 s degree relative (SDR), ≥ 3 any degree relatives (ADR), or any known hereditary cancer syndrome with increased PC risk. Imaging with 3.0 T MRI was performed routinely and endoscopic ultrasound was used selectively. Screening was completed in 75 patients (pts). Hereditary cancer syndromes were present in 42 (56%) of the 75 pts: BRCA2 (18), ATM (8), BRCA1 (6), CDKN2A (4), PALB2 (3), Lynch (2), and Peutz-Jeghers (1). A family history of PC was present in ≥ 2 FDR in 12 (16%) pts, 1 FDR and 1 SDR in 5 (7) pts, and ≥ 3 ADR in 16 (21%) pts. Of the 65 pts who received screening MRI, 28 (43%) pts had pancreatic cystic lesions identified, including 1 (1%) patient in whom a cholangiocarcinoma was diagnosed as well. No patient underwent surgical resection. Using a 3.0 T MRI to screen patients at high risk for developing PC identified radiographic abnormalities in 43% of patients, which were stable on subsequent surveillance. Specific guidelines for the frequency of surveillance and indications for surgery remain areas of active investigation as the global experience with high risk screening continues to mature.

Citing Articles

Aspects and outcomes of surveillance for individuals at high-risk of pancreatic cancer.

Bogdanski A, van Hooft J, Boekestijn B, Bonsing B, Wasser M, Klatte D Fam Cancer. 2024; 23(3):323-339.

PMID: 38619782 PMC: 11255004. DOI: 10.1007/s10689-024-00368-1.

Cost-Effectiveness Analysis of Screening for Pancreatic Cancer Among High-Risk Populations.

Peters M, Eckel A, Seguin C, Davidi B, Howard D, Knudsen A JCO Oncol Pract. 2023; 20(2):278-290.

PMID: 38086003 PMC: 10911581. DOI: 10.1200/OP.23.00495.

Risk Assessment and Pancreatic Cancer: Diagnostic Management and Artificial Intelligence.

Granata V, Fusco R, Setola S, Galdiero R, Maggialetti N, Silvestro L Cancers (Basel). 2023; 15(2).

PMID: 36672301 PMC: 9857317. DOI: 10.3390/cancers15020351.

Current Screening Strategies for Pancreatic Cancer.

Vanek P, Urban O, Zoundjiekpon V, Falt P Biomedicines. 2022; 10(9).

PMID: 36140157 PMC: 9495594. DOI: 10.3390/biomedicines10092056.

Genetic testing to guide screening for pancreatic ductal adenocarcinoma: Results of a microsimulation model.

Peters M, Eckel A, Lietz A, Seguin C, Mueller P, Hur C Pancreatology. 2022; 22(6):760-769.

PMID: 35752568 PMC: 9474673. DOI: 10.1016/j.pan.2022.05.003.

References

Poley J, Kluijt I, Gouma D, Harinck F, Wagner A, Aalfs C . The yield of first-time endoscopic ultrasonography in screening individuals at a high risk of developing pancreatic cancer. Am J Gastroenterol. 2009; 104(9):2175-81. DOI: 10.1038/ajg.2009.276. View

. American Society of Clinical Oncology policy statement update: genetic testing for cancer susceptibility. J Clin Oncol. 2003; 21(12):2397-406. DOI: 10.1200/JCO.2003.03.189. View

Hu C, Hart S, Bamlet W, Moore R, Nandakumar K, Eckloff B . Prevalence of Pathogenic Mutations in Cancer Predisposition Genes among Pancreatic Cancer Patients. Cancer Epidemiol Biomarkers Prev. 2015; 25(1):207-11. PMC: 4754121. DOI: 10.1158/1055-9965.EPI-15-0455. View

Langer P, Kann P, Fendrich V, Habbe N, Schneider M, Sina M . Five years of prospective screening of high-risk individuals from families with familial pancreatic cancer. Gut. 2009; 58(10):1410-8. DOI: 10.1136/gut.2008.171611. View

Syngal S, Brand R, Church J, Giardiello F, Hampel H, Burt R . ACG clinical guideline: Genetic testing and management of hereditary gastrointestinal cancer syndromes. Am J Gastroenterol. 2015; 110(2):223-62. PMC: 4695986. DOI: 10.1038/ajg.2014.435. View

Bartsch D, Dietzel K, Bargello M, Matthaei E, Kloeppel G, Esposito I . Multiple small "imaging" branch-duct type intraductal papillary mucinous neoplasms (IPMNs) in familial pancreatic cancer: indicator for concomitant high grade pancreatic intraepithelial neoplasia?. Fam Cancer. 2012; 12(1):89-96. DOI: 10.1007/s10689-012-9582-y. View

Shi C, Klein A, Goggins M, Maitra A, Canto M, Ali S . Increased Prevalence of Precursor Lesions in Familial Pancreatic Cancer Patients. Clin Cancer Res. 2009; 15(24):7737-7743. PMC: 2795080. DOI: 10.1158/1078-0432.CCR-09-0004. View

Winter J, Cameron J, Campbell K, Arnold M, Chang D, Coleman J . 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg. 2006; 10(9):1199-210. DOI: 10.1016/j.gassur.2006.08.018. View

Potjer T, Schot I, Langer P, Heverhagen J, Wasser M, Slater E . Variation in precursor lesions of pancreatic cancer among high-risk groups. Clin Cancer Res. 2012; 19(2):442-9. DOI: 10.1158/1078-0432.CCR-12-2730. View

10.

Brentnall T, Bronner M, Byrd D, Haggitt R, Kimmey M . Early diagnosis and treatment of pancreatic dysplasia in patients with a family history of pancreatic cancer. Ann Intern Med. 1999; 131(4):247-55. DOI: 10.7326/0003-4819-131-4-199908170-00003. View

11.

Brune K, Abe T, Canto M, OMalley L, Klein A, Maitra A . Multifocal neoplastic precursor lesions associated with lobular atrophy of the pancreas in patients having a strong family history of pancreatic cancer. Am J Surg Pathol. 2006; 30(9):1067-76. PMC: 2746409. DOI: pas.0000213265.84725.0b. View

12.

Ludwig E, Olson S, Bayuga S, Simon J, Schattner M, Gerdes H . Feasibility and yield of screening in relatives from familial pancreatic cancer families. Am J Gastroenterol. 2011; 106(5):946-54. PMC: 3683863. DOI: 10.1038/ajg.2011.65. View

13.

Canto M, Hruban R, Fishman E, Kamel I, Schulick R, Zhang Z . Frequent detection of pancreatic lesions in asymptomatic high-risk individuals. Gastroenterology. 2012; 142(4):796-804. PMC: 3321068. DOI: 10.1053/j.gastro.2012.01.005. View

14.

Yachida S, Jones S, Bozic I, Antal T, Leary R, Fu B . Distant metastasis occurs late during the genetic evolution of pancreatic cancer. Nature. 2010; 467(7319):1114-7. PMC: 3148940. DOI: 10.1038/nature09515. View

15.

Edelman R, Salanitri G, Brand R, Dunkle E, Ragin A, Li W . Magnetic resonance imaging of the pancreas at 3.0 tesla: qualitative and quantitative comparison with 1.5 tesla. Invest Radiol. 2006; 41(2):175-80. DOI: 10.1097/01.rli.0000195880.69880.6c. View

16.

Bartsch D, Gress T, Langer P . Familial pancreatic cancer--current knowledge. Nat Rev Gastroenterol Hepatol. 2012; 9(8):445-53. DOI: 10.1038/nrgastro.2012.111. View

17.

Vasen H, Ibrahim I, Guillen Ponce C, Slater E, Matthai E, Carrato A . Benefit of Surveillance for Pancreatic Cancer in High-Risk Individuals: Outcome of Long-Term Prospective Follow-Up Studies From Three European Expert Centers. J Clin Oncol. 2016; 34(17):2010-9. DOI: 10.1200/JCO.2015.64.0730. View

18.

Vasen H, Wasser M, van Mil A, Tollenaar R, Konstantinovski M, Gruis N . Magnetic resonance imaging surveillance detects early-stage pancreatic cancer in carriers of a p16-Leiden mutation. Gastroenterology. 2010; 140(3):850-6. DOI: 10.1053/j.gastro.2010.11.048. View

19.

Richards C, Bale S, Bellissimo D, Das S, Grody W, Hegde M . ACMG recommendations for standards for interpretation and reporting of sequence variations: Revisions 2007. Genet Med. 2008; 10(4):294-300. DOI: 10.1097/GIM.0b013e31816b5cae. View

20.

Brentnall T . Pancreatic cancer surveillance: learning as we go. Am J Gastroenterol. 2011; 106(5):955-6. DOI: 10.1038/ajg.2011.68. View