Screening for early pancreatic neoplasia in high-risk individuals: A prospective controlled study

被引:384
作者
Canto, Marcia Irene
Goggins, Michael
Hruban, Ralph H.
Petersen, Gloria M.
Giardiello, Francis M.
Yeo, Charles
Fishman, Elliott K.
Brune, Kieran
Axilbund, Jennifer
Griffin, Constance
Ali, Syed
Richman, Jeffrey
Jagannath, Sanjay
Kantsevoy, Sergey V.
Kalloo, Anthony N.
机构
[1] Johns Hopkins Med Inst, Sol Goldman Pancreat Canc Res Ctr, Dept Med Gastroenterol, Baltimore, MD 21205 USA
[2] Johns Hopkins Med Inst, Sol Goldman Pancreat Canc Res Ctr, Dept Pathol, Baltimore, MD 21205 USA
[3] Johns Hopkins Med Inst, Sol Goldman Pancreat Canc Res Ctr, Dept Surg, Baltimore, MD 21205 USA
[4] Johns Hopkins Med Inst, Sol Goldman Pancreat Canc Res Ctr, Dept Oncol, Baltimore, MD 21205 USA
[5] Johns Hopkins Med Inst, Sol Goldman Pancreat Canc Res Ctr, Dept Radiol, Baltimore, MD 21205 USA
[6] Johns Hopkins Med Inst, Sol Goldman Pancreat Canc Res Ctr, Dept Anesthesiol, Baltimore, MD 21205 USA
[7] Mayo Clin, Coll Med, Div Epidemiol, Rochester, MN USA
关键词
D O I
10.1016/j.cgh.2006.02.005
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background & Aims: Individuals with a strong family history of pancreatic cancer and persons with Peutz-Jeghers syndrome (PJS) have an increased risk for pancreatic cancer. This study screened for early pancreatic neoplasia and compared the pancreatic abnormalities in high-risk individuals and control subjects. Methods: High-risk individuals with PJS or a strong family history of pancreatic cancer were prospectively evaluated with baseline and 12-month computed tomography (CT) scan and endoscopic ultrasonography (EUS). If EUS was abnormal, EUS-fine-needle aspiration and endoscopic retrograde cholangiopancreatography (ERCP) were performed. Surgery was offered to patients with potentially neoplastic lesions. Radiologic findings and pathologic diagnoses were compared. Patients undergoing EUS and/or ERCP for benign non-pancreatic indications were concurrently enrolled as control subjects. Results: Seventy-eight high-risk patients (72 from familial pancreatic cancer kindreds, 6 PJS) and 149 control patients were studied. To date, 8 patients with pancreatic neoplasia have been confirmed by surgery or fine-needle aspiration (10% yield of screening); 6 patients had 8 benign intraductal papillary mucinous neoplasms (IPMNs), 1 had an IPMN that progressed to invasive ductal adenocarcinoma, and 1 had pancreatic intraepithelial neoplasia. EUS and CT also diagnosed 3 patients with 5 extrapancreatic neoplasms. At EUS and ERCP abnormalities suggestive of chronic pancreatitis were more common in high-risk patients than in control subjects. Conclusions: Screening EUS and CT diagnosed significant asymptomatic pancreatic and extrapancreatic neoplasms in high-risk individuals. IPMN should be considered a part of the phenotype of familial pancreatic cancer. Abnormalities suggestive of chronic pancreatitis are identified more commonly at EUS and ERCP in high-risk individuals.
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页码:766 / 781
页数:16
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