Screening was performed annually with either endoscopic ultrasound (EUS) or magnetic resonance cholangiopancreatography (MRCP). Fasting blood sugar was recorded annually to screen for new-onset diabetes.
Among 252 patients, 208 underwent EUS and 44 underwent MRCP. At the time of enrollment, 38.5% underwent their first screening, and 61.5% had a prior screening. The average age was 60, 69% were women, and 79% were White.
The most common indication was a BRCA1 or BRCA2 pathogenic variant in 93 patients (or 36.5%), followed by FPC syndrome in 80 patients (or 31.7%).
Low-risk pancreas pathology was noted in 23.4% of patients, with 17.5% having chronic pancreatitis-like changes. Intermediate risk was found in 31.7%, with nearly all detected as branch-duct IPMNs without worrisome features, Dr. Silva-Santisteban said.
Two patients (.8%) fell into the high-risk category with pancreatic adenocarcinoma. Both were positive for BRCA2 mutation and family history of pancreatic cancer.
In the first patient, who was compliant with screening, EUS showed a 3-cm adenocarcinoma (T2N1M0 stage IIB). The patient underwent neoadjuvant chemotherapy, followed by total pancreatectomy, and is currently in cancer remission. No complications from surgery were noted.
In the second patient, who was not compliant with screening and was lost to follow-up for 6 years, EUS showed a 2.5-cm adenocarcinoma and four metastatic lesions in the liver (T2N1M1 stage IV). The patient underwent palliative chemotherapy.
EUS was more likely to identify chronic pancreatitis-like changes, but MRCP was more likely to identify BD-IPMN. The two patients with pancreatic adenocarcinoma were identified with EUS. However, there wasn’t a significant difference between EUS and MRCP in identifying high-risk lesions.
In patients undergoing screening, new-onset prediabetes was noted in 18.2%, and new-onset diabetes was noted in 1.7%. However, there was no association between abnormal blood sugar and pancreas pathology.
Twelve patients (4.8%) underwent further pancreatic evaluation because of screening findings. None of the patients underwent low-yield pancreatic surgery, which was lower than reported in the literature, at 2.8%. Overall, there were no complications as a direct result of screening with EUS or MRI.
“Patients should be carefully counseled regarding benefits and harms from pancreatic cancer screening,” Dr. Silva-Santisteban said. “When feasible, such screening should be performed within the confines of a research study so more precise estimates of screening outcomes can be determined.”
The study funding was not disclosed. One author reported a consultant relationship with Pentax Medical, and the other authors indicated no relevant financial relationships.
