Alternation of MRI and EUS in pancreatic cancer screening could increase detection of both pancreatic and extra-pancreatic findings

Aims Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers, with screening policies to detect it at earlier stages currently restricted to research programmes dedicated to high-risk individuals (HRIs), including mutation carriers and/or familial pancreatic cancer (FPC) kindreds. Surveillance studies focus on pancreatic findings, nonetheless these individuals could be at risk of minor pancreatic findings, known to be associated with PanIN alterations, as also extra-pancreatic neoplasia due to their genetic background. However, evidence on these findings in course of screening is scarce and which imaging technique between superior abdomen magnetic resonance (MRI) and endoscopic ultrasound (EUS) should be employed is still debated. Our aim is to describe pancreatic and extra-pancreatic findings during follow-up in HRIs recruited in two centres of the Italian Registry of Families at Risk of Pancreatic Cancer (IRFARPC).

Methods Patients enrolled in IRFARPC centers employing surveillance with alternation of MRIand EUS were included, recording age at screening start, risk category, risk factors, findings at two rounds, one with MRI and one with EUS, both pancreatic and extra-pancreatic. Data were analyzed using descriptive statistics, with numbers and percentages, and Chi-squared test was employed to compare categorical data.

Results One hundred and fifty-one patients were enrolled in the two centres. Mean age at surveillance start was 54±9.7 years, 42.3% being males; 96 (63.5%) were FPC, 23 (15.2%) BRCA1/2 mutated, 2 (1.3%) Lynch syndrome, 11 (7.2%) FAMMM, 3 (1.9%) PALB2 mutation, 8 (5.2%) ATM mutation, 4 (2.6%) Peutz-Jeghers syndrome, 7 (4.6%) genetic chronic pancreatitis. Pancreatic abnormalities at first round were found in 68.2% of patients, including cysts (45%), early chronic pancreatitis (17.8%), vanishing pancreas (9.2%), main pancreatic duct dilation (4%), chronic pancreatitis (3.3%) and solid lesions (1.3%). Extra-pancreatic abnormalities were found in 54.3% of patients during first round, including benign lesions such as kidney cysts (23.2%), liver cysts (21.8%), liver angiomas (11.9%), accessory spleens (6%), liver FNH (2%), spleen angiomas (1.3%), liver adenomas (0.7%), and those with malignant potential such as mammalian nodules (0.7%) and adrenal adenomas (0.7%). Patients with identification of extra-pancreatic findings had undergone in 80% of cases MRI and in 20% EUS (p<0.0001), while patients with pancreatic findings had undergone in 31.4% of cases MRI and in 68.6% EUS (p<0.0001).

Conclusions Whether HRIs undergoing screening programs should undergo both EUS and MRI is still debated. EUS seems to detect more frequently pancreatic alterations, known to be associated to microscopic alterations, while MRI could be optimal for identification of extra-pancreatic findings. An alternation of the two imaging modalities could be optimal to improve detection of relevant findings.

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Artikel online veröffentlicht:
27. März 2025