Detection of Familial Pancreatic Neoplasms by Endoscopic Ultrasonography, MDCT, and MR Cholangiopancreatography

Lives can be saved if high-grade dysplasia and early familial ductal adenocarcinoma can be detected in high-risk individuals before these lesions progress to advanced disease. In a recent study, researchers evaluated different imaging modalities for preoperative detection of familial pancreatic neoplasms.

The investigators looked to characterize pancreatic neoplastic lesions detected by imaging tests in high-risk individuals; to compare the diagnostic yield and incremental benefit of endoscopic ultrasonography (EUS) over multidetector computed tomography (MDCT)/magnetic resonance cholangiopancreatography (MRCP); and to determine the incremental benefit of fine-needle aspiration (FNA) over EUS alone.

Data prospectively collected by investigators led by Marcia I. Canto, M.D., FASGE, an associate professor of medicine and oncology at Johns Hopkins University (Baltimore, MD, USA), from 1998-2007 from two screening studies and the center's clinical screening program were analyzed. High-risk individuals with Peutz-Jeghers syndrome or first-degree relatives from familial ductal adenocarcinoma kindreds with at least two affected, had MDCT or MRI/MRCP or both, and EUS. Radiologic and EUS features of each preoperatively detected lesion were compared with the pathologic findings. The diagnostic yield of each imaging modality was calculated on a per-lesion basis.

Of 165 patients who had EUS and CT/MRCP, 19 asymptomatic high-risk individuals underwent partial resection (15), partial followed by completion pancreatectomy (3), or total pancreatectomy (1) for 44 pancreatic lesions (size range 2.6-21 mm) detected by EUS, MDCT, or MRCP.

The researchers concluded that most pancreatic neoplasms detected by screening tests are small and low grade, but 6% of intraductal papillary mucinous neoplasms < 3 cm may contain high-grade dysplasia. EUS detects almost twice as many neoplastic lesions as CT/MRCP, regardless of size, and FNA adds little to EUS.

The study's findings were presented in May 2008, at the Digestive Disease Week (DDW) 2008, held in San Diego, CA, USA.

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