Pancreatic Cysts Greater Than 1 Cm Are Associated With an Increased Risk for Developing Pancreatic Cancer in Individuals From Pancreatic-Cancer Prone Kindreds Undergoing Surveillance

Overview

Journal Pancreas

Specialty Gastroenterology

Date 2024 Mar 22

PMID 38518061

Authors

Muaz Aijazi

Kenneth E Fasanella

Kevin McGrath

Lynette M Smith

Aatur D Singhi

Randall E Brand

Affiliations

Soon will be listed here.

Abstract

Background: The International Cancer of the Pancreas Screening Consortium recommended annual imaging for individuals at increased risk for developing a pancreatic ductal adenocarcinoma (PDAC) who did not have concerning pancreatic findings or a cyst <3 cm without worrisome features. We aimed to determine if 3-cm cyst size accurately predicted advanced precursor lesions in high-risk individuals undergoing surveillance.

Methods: Imaging for high-risk individuals (HRIs) undergoing PDAC surveillance from 2007 to 2021 was reviewed and pancreatic abnormalities were recorded including dominant cyst size and number of cysts. Subjects were excluded if they had the following: (1) no follow-up imaging after baseline, (2) solid lesion at baseline, or (3) development of solid lesion without having cyst on prior imaging.

Results: Five of the 77 HRIs found to have a cystic lesion on surveillance developed a PDAC: 3 with cystic lesion >1 cm as compared with only 2 of 67 HRIs with cystic lesions <1 cm (P < 0.05). None of these cysts developed worrisome findings and 4/5 PDACs did not arise from visualized cystic precursor lesion.

Conclusions: Patients with a cyst ≥1 cm were at increased risk for developing PDAC compared with patients with cyst <1 cm. Pancreatic ductal adenocarcinoma usually did not arise from a recognized cystic lesion.

References

Konings I, Harinck F, Poley J, Aalfs C, Rens A, Krak N . Prevalence and Progression of Pancreatic Cystic Precursor Lesions Differ Between Groups at High Risk of Developing Pancreatic Cancer. Pancreas. 2016; 46(1):28-34. DOI: 10.1097/MPA.0000000000000725. View

Vege S, Ziring B, Jain R, Moayyedi P . American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015; 148(4):819-22. DOI: 10.1053/j.gastro.2015.01.015. View

van Huijgevoort N, Del Chiaro M, Wolfgang C, van Hooft J, Besselink M . Diagnosis and management of pancreatic cystic neoplasms: current evidence and guidelines. Nat Rev Gastroenterol Hepatol. 2019; 16(11):676-689. DOI: 10.1038/s41575-019-0195-x. View

Izawa T, Obara T, Tanno S, Mizukami Y, Yanagawa N, Kohgo Y . Clonality and field cancerization in intraductal papillary-mucinous tumors of the pancreas. Cancer. 2001; 92(7):1807-17. DOI: 10.1002/1097-0142(20011001)92:7<1807::aid-cncr1697>3.0.co;2-0. View

Goggins M, Overbeek K, Brand R, Syngal S, Del Chiaro M, Bartsch D . Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium. Gut. 2019; 69(1):7-17. PMC: 7295005. DOI: 10.1136/gutjnl-2019-319352. 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

Tanaka M, Fernandez-Del Castillo C, Adsay V, Chari S, Falconi M, Jang J . International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012; 12(3):183-97. DOI: 10.1016/j.pan.2012.04.004. View

Rutter M, East J, Rees C, Cripps N, Docherty J, Dolwani S . British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines. Gut. 2019; 69(2):201-223. PMC: 6984062. DOI: 10.1136/gutjnl-2019-319858. 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

10.

Ilic M, Ilic I . Epidemiology of pancreatic cancer. World J Gastroenterol. 2016; 22(44):9694-9705. PMC: 5124974. DOI: 10.3748/wjg.v22.i44.9694. View

11.

Park W, Chawla A, OReilly E . Pancreatic Cancer: A Review. JAMA. 2021; 326(9):851-862. PMC: 9363152. DOI: 10.1001/jama.2021.13027. View

12.

Tanaka M, Fernandez-Del Castillo C, Kamisawa T, Jang J, Levy P, Ohtsuka T . Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 2017; 17(5):738-753. DOI: 10.1016/j.pan.2017.07.007. View

13.

Chun Y, Pawlik T, Vauthey J . 8th Edition of the AJCC Cancer Staging Manual: Pancreas and Hepatobiliary Cancers. Ann Surg Oncol. 2017; 25(4):845-847. DOI: 10.1245/s10434-017-6025-x. View

14.

Overbeek K, Levink I, Koopmann B, Harinck F, Konings I, Ausems M . Long-term yield of pancreatic cancer surveillance in high-risk individuals. Gut. 2021; 71(6):1152-1160. PMC: 9120399. DOI: 10.1136/gutjnl-2020-323611. View

15.

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

16.

. European evidence-based guidelines on pancreatic cystic neoplasms. Gut. 2018; 67(5):789-804. PMC: 5890653. DOI: 10.1136/gutjnl-2018-316027. View

17.

Saad A, Turk T, Al-Husseini M, Abdel-Rahman O . Trends in pancreatic adenocarcinoma incidence and mortality in the United States in the last four decades; a SEER-based study. BMC Cancer. 2018; 18(1):688. PMC: 6020186. DOI: 10.1186/s12885-018-4610-4. View

18.

Dbouk M, Brewer Gutierrez O, Lennon A, Chuidian M, Shin E, Kamel I . Guidelines on management of pancreatic cysts detected in high-risk individuals: An evaluation of the 2017 Fukuoka guidelines and the 2020 International Cancer of the Pancreas Screening (CAPS) consortium statements. Pancreatology. 2021; 21(3):613-621. DOI: 10.1016/j.pan.2021.01.017. View

19.

Owens D, Davidson K, Krist A, Barry M, Cabana M, Caughey A . Screening for Pancreatic Cancer: US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA. 2019; 322(5):438-444. DOI: 10.1001/jama.2019.10232. View

20.

Matthaei H, Norris A, Tsiatis A, Olino K, Hong S, Dal Molin M . Clinicopathological characteristics and molecular analyses of multifocal intraductal papillary mucinous neoplasms of the pancreas. Ann Surg. 2011; 255(2):326-33. PMC: 3534752. DOI: 10.1097/SLA.0b013e3182378a18. View