Screening for pancreatic neoplasia in high-risk individuals: An EUS-based approach

Marcia Irene Canto; Michael Goggins; Charles J. Yeo; Constance Griffin; Jennifer E. Axilbund; Kieran Brune; Syed Z. Ali; Sanjay Jagannath; Gloria M. Petersen; Elliot K. Fishman; Steven Piantadosi; Francis M. Giardiello; Ralph H. Hruban

doi:10.1016/S1542-3565(04)00244-7

Screening for pancreatic neoplasia in high-risk individuals: An EUS-based approach

Título traducido de la contribución: Detección de neoplasia pancreática en individuos de alto riesgo: Un enfoque basado en la ecoendoscopia

Marcia Irene Canto, Michael Goggins, Charles J. Yeo, Constance Griffin, Jennifer E. Axilbund, Kieran Brune, Syed Z. Ali, Sanjay Jagannath, Gloria M. Petersen, Elliot K. Fishman, Steven Piantadosi, Francis M. Giardiello, Ralph H. Hruban

Producción: Contribución a una revista › Artículo › revisión exhaustiva

404 Citas (Scopus)

Resumen

Antecedentes y objetivos: Los familiares de pacientes con cáncer de páncreas y las personas con ciertos síndromes hereditarios tienen mayor riesgo de desarrollar cáncer de páncreas. Evaluamos prospectivamente la viabilidad del cribado de neoplasia pancreática en individuos de alto riesgo. Métodos: Los individuos de familias con cáncer de páncreas familiar y un paciente con síndrome de Peutz-Jeghers se sometieron a una ecografía endoscópica (EUS) de cribado. Si la EUS era anormal, se realizaba una aspiración con aguja fina guiada por EUS, una colangiopancreatografía retrógrada endoscópica (CPRE) y una tomografía computarizada espiral (TC). Los pacientes con anomalías que sugerían neoplasia fueron sometidos a cirugía. Resultados: Se estudiaron treinta y ocho pacientes; 31 (edad media, 58 años; 42% hombres) de familias con ≥3 afectados con cáncer de páncreas; 6 de familias con 2 familiares afectados, 1 era un paciente con síndrome de Peutz-Jeghers. Ninguno presentó síntomas atribuibles al páncreas ni sugestivos de malignidad. Se encontraron seis masas pancreáticas mediante ecoendoscopia: 1 adenocarcinoma ductal invasivo, 1 neoplasia mucinosa papilar intraductal benigna, 2 cistoadenomas serosos y 2 masas no neoplásicas. Por lo tanto, el rendimiento diagnóstico para detectar neoplasias pancreáticas clínicamente significativas fue del 5,3 % (2 de 38). El paciente con cáncer de páncreas fue tratado y sigue vivo y libre de enfermedad >5 años después de la cirugía. Se encontraron cambios en la ecoendoscopia similares a los asociados con la pancreatitis crónica, que fueron más comunes en pacientes con antecedentes de consumo regular de alcohol (P = 0,02), pero también se produjeron en pacientes que no consumían alcohol. El cribado también condujo a un nuevo diagnóstico y tratamiento de afecciones gastrointestinales superiores sintomáticas en el 18,4 % de los pacientes. Conclusiones: El cribado basado en ecoendoscopia de individuos asintomáticos de alto riesgo puede detectar neoplasia pancreática resecable prevalente, pero también se producen diagnósticos falsos positivos.

Título traducido de la contribución	Detección de neoplasia pancreática en individuos de alto riesgo: Un enfoque basado en la ecoendoscopia
Idioma original	Inglés
Páginas (desde-hasta)	606-621
Número de páginas	16
Publicación	Clinical Gastroenterology and Hepatology
Volumen	2
N.º	7
DOI	https://doi.org/10.1016/S1542-3565(04)00244-7
Estado	Publicada - jul. 2004
Publicado de forma externa	Sí

Palabras clave

tomografía computarizada
TC
colangiopancreatografía retrógrada endoscópica
ecografía endoscópica
CPRE
EE
aspiración con aguja fina
PAAF
neoplasia mucinosa papilar intraductal
IPMN
Registro Nacional de Tumores de Páncreas Familiares
NFPTR
PanIN

ODS de las Naciones Unidas

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Canto, M. I., Goggins, M., Yeo, C. J., Griffin, C., Axilbund, J. E., Brune, K., Ali, S. Z., Jagannath, S., Petersen, G. M., Fishman, E. K., Piantadosi, S., Giardiello, F. M., & Hruban, R. H. (2004). Screening for pancreatic neoplasia in high-risk individuals: An EUS-based approach. Clinical Gastroenterology and Hepatology, 2(7), 606-621. https://doi.org/10.1016/S1542-3565(04)00244-7

@article{8ea3fc884ca0491d837c93f692b71260,

title = "Screening for pancreatic neoplasia in high-risk individuals: An EUS-based approach",

abstract = "Background \& Aims: Relatives of patients with pancreatic cancer and persons with certain inherited syndromes are at increased risk for developing pancreatic cancer. We prospectively evaluated the feasibility of screening for pancreatic neoplasia in high-risk individuals. Methods: Individuals from familial pancreatic cancer kindreds and a patient with Peutz-Jeghers syndrome underwent screening endoscopic ultrasound (EUS). If the EUS was abnormal, EUS-guided fine-needle aspiration, endoscopic retrograde cholangiopancreatography (ERCP), and spiral computed tomography (CT) were performed. Patients with abnormalities suggesting neoplasia had surgery. Results: Thirty-eight patients were studied; 31 (mean age, 58 yr; 42\% men) from kindreds with ≥3 affected with pancreatic cancer; 6 from kindreds with 2 affected relatives, 1 was a patient with Peutz-Jeghers syndrome. None had symptoms referable to the pancreas or suggestive of malignancy. Six pancreatic masses were found by EUS: 1 invasive ductal adenocarcinoma, 1 benign intraductal papillary mucinous neoplasm, 2 serous cystadenomas, and 2 nonneoplastic masses. Hence, the diagnostic yield for detecting clinically significant pancreatic neoplasms was 5.3\% (2 of 38). The 1 patient with pancreatic cancer was treated and still is alive and disease-free >5 years after surgery. EUS changes similar to those associated with chronic pancreatitis were found, which were more common in patients with a history of regular alcohol intake (P = 0.02), but also occurred in patients who did not consume alcohol. Screening also led to a new diagnosis and treatment of symptomatic upper-gastrointestinal conditions in 18.4\% of patients. Conclusions: EUS-based screening of asymptomatic high-risk individuals can detect prevalent resectable pancreatic neoplasia but false-positive diagnoses also occur.",

keywords = "computed tomography, CT, endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography, ERCP, EUS, fine-needle aspiration, FNA, intraductal papillary mucinous neoplasm, IPMN, National Familial Pancreas Tumor Registry, NFPTR, PanIN, tomograf{\'i}a computarizada, TC, colangiopancreatograf{\'i}a retr{\'o}grada endosc{\'o}pica, ecograf{\'i}a endosc{\'o}pica, CPRE, EE, aspiraci{\'o}n con aguja fina, PAAF, neoplasia mucinosa papilar intraductal, IPMN, Registro Nacional de Tumores de P{\'a}ncreas Familiares, NFPTR, PanIN",

author = "Canto, \{Marcia Irene\} and Michael Goggins and Yeo, \{Charles J.\} and Constance Griffin and Axilbund, \{Jennifer E.\} and Kieran Brune and Ali, \{Syed Z.\} and Sanjay Jagannath and Petersen, \{Gloria M.\} and Fishman, \{Elliot K.\} and Steven Piantadosi and Giardiello, \{Francis M.\} and Hruban, \{Ralph H.\}",

year = "2004",

month = jul,

doi = "10.1016/S1542-3565(04)00244-7",

language = "English",

volume = "2",

pages = "606--621",

journal = "Clinical Gastroenterology and Hepatology",

issn = "1542-3565",

publisher = "W.B. Saunders",

number = "7",

}

TY - JOUR

T1 - Screening for pancreatic neoplasia in high-risk individuals

T2 - An EUS-based approach

AU - Canto, Marcia Irene

AU - Goggins, Michael

AU - Yeo, Charles J.

AU - Griffin, Constance

AU - Axilbund, Jennifer E.

AU - Brune, Kieran

AU - Ali, Syed Z.

AU - Jagannath, Sanjay

AU - Petersen, Gloria M.

AU - Fishman, Elliot K.

AU - Piantadosi, Steven

AU - Giardiello, Francis M.

AU - Hruban, Ralph H.

PY - 2004/7

Y1 - 2004/7

N2 - Background & Aims: Relatives of patients with pancreatic cancer and persons with certain inherited syndromes are at increased risk for developing pancreatic cancer. We prospectively evaluated the feasibility of screening for pancreatic neoplasia in high-risk individuals. Methods: Individuals from familial pancreatic cancer kindreds and a patient with Peutz-Jeghers syndrome underwent screening endoscopic ultrasound (EUS). If the EUS was abnormal, EUS-guided fine-needle aspiration, endoscopic retrograde cholangiopancreatography (ERCP), and spiral computed tomography (CT) were performed. Patients with abnormalities suggesting neoplasia had surgery. Results: Thirty-eight patients were studied; 31 (mean age, 58 yr; 42% men) from kindreds with ≥3 affected with pancreatic cancer; 6 from kindreds with 2 affected relatives, 1 was a patient with Peutz-Jeghers syndrome. None had symptoms referable to the pancreas or suggestive of malignancy. Six pancreatic masses were found by EUS: 1 invasive ductal adenocarcinoma, 1 benign intraductal papillary mucinous neoplasm, 2 serous cystadenomas, and 2 nonneoplastic masses. Hence, the diagnostic yield for detecting clinically significant pancreatic neoplasms was 5.3% (2 of 38). The 1 patient with pancreatic cancer was treated and still is alive and disease-free >5 years after surgery. EUS changes similar to those associated with chronic pancreatitis were found, which were more common in patients with a history of regular alcohol intake (P = 0.02), but also occurred in patients who did not consume alcohol. Screening also led to a new diagnosis and treatment of symptomatic upper-gastrointestinal conditions in 18.4% of patients. Conclusions: EUS-based screening of asymptomatic high-risk individuals can detect prevalent resectable pancreatic neoplasia but false-positive diagnoses also occur.

AB - Background & Aims: Relatives of patients with pancreatic cancer and persons with certain inherited syndromes are at increased risk for developing pancreatic cancer. We prospectively evaluated the feasibility of screening for pancreatic neoplasia in high-risk individuals. Methods: Individuals from familial pancreatic cancer kindreds and a patient with Peutz-Jeghers syndrome underwent screening endoscopic ultrasound (EUS). If the EUS was abnormal, EUS-guided fine-needle aspiration, endoscopic retrograde cholangiopancreatography (ERCP), and spiral computed tomography (CT) were performed. Patients with abnormalities suggesting neoplasia had surgery. Results: Thirty-eight patients were studied; 31 (mean age, 58 yr; 42% men) from kindreds with ≥3 affected with pancreatic cancer; 6 from kindreds with 2 affected relatives, 1 was a patient with Peutz-Jeghers syndrome. None had symptoms referable to the pancreas or suggestive of malignancy. Six pancreatic masses were found by EUS: 1 invasive ductal adenocarcinoma, 1 benign intraductal papillary mucinous neoplasm, 2 serous cystadenomas, and 2 nonneoplastic masses. Hence, the diagnostic yield for detecting clinically significant pancreatic neoplasms was 5.3% (2 of 38). The 1 patient with pancreatic cancer was treated and still is alive and disease-free >5 years after surgery. EUS changes similar to those associated with chronic pancreatitis were found, which were more common in patients with a history of regular alcohol intake (P = 0.02), but also occurred in patients who did not consume alcohol. Screening also led to a new diagnosis and treatment of symptomatic upper-gastrointestinal conditions in 18.4% of patients. Conclusions: EUS-based screening of asymptomatic high-risk individuals can detect prevalent resectable pancreatic neoplasia but false-positive diagnoses also occur.

KW - computed tomography

KW - CT

KW - endoscopic retrograde cholangiopancreatography

KW - endoscopic ultrasonography

KW - ERCP

KW - EUS

KW - fine-needle aspiration

KW - FNA

KW - intraductal papillary mucinous neoplasm

KW - IPMN

KW - National Familial Pancreas Tumor Registry

KW - NFPTR

KW - PanIN

KW - tomografía computarizada

KW - TC

KW - colangiopancreatografía retrógrada endoscópica

KW - ecografía endoscópica

KW - CPRE

KW - EE

KW - aspiración con aguja fina

KW - PAAF

KW - neoplasia mucinosa papilar intraductal

KW - IPMN

KW - Registro Nacional de Tumores de Páncreas Familiares

KW - NFPTR

KW - PanIN

UR - https://www.scopus.com/pages/publications/3042525898

U2 - 10.1016/S1542-3565(04)00244-7

DO - 10.1016/S1542-3565(04)00244-7

M3 - Article

C2 - 15224285

AN - SCOPUS:3042525898

SN - 1542-3565

VL - 2

SP - 606

EP - 621

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

IS - 7

ER -

Screening for pancreatic neoplasia in high-risk individuals: An EUS-based approach

Resumen

Palabras clave

ODS de las Naciones Unidas

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