Role of Screening Endoscopic Ultrasound in High-Risk Pancreatic Cancer Patients: When all findings matter

Aims Pancreatic cancer surveillance can improve outcomes in individuals with an increased risk of pancreatic cancer (PC) based on family history or germline mutation status. Screening is mainly based on annual magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS). Although the likelihood of detecting relevant lesions has been evaluated, little has been described regarding the possibility of finding other morphological changes that may also be important. The aim of the study is to evaluate all the findings described in EUS performed during pancreatic cancer screening in high-risk patients.

Methods This descriptive observational study includes high-risk PC patients either due to family history (familial pancreatic cancer) or because they belong to hereditary syndromes meeting PC screening criteria, who had undergone at least one EUS from 2015 to 2023. Demographic variables and findings described in the EUS were collected

Results During the study period, thirty-five patients were included, with a mean age of 57.3±8.2 years and a predominance of females (65.7%). Four patients (11.4%) were smokers, two were diabetic (5.7%), and one had a history of chronic pancreatitis (2.9%) [1] [2]. The most frequent hereditary syndrome was hereditary breast and ovarian cancer (n=19, 54.3%), followed by familial atypical multiple mole melanoma syndrome (n=4; 11.4%). Other hereditary conditions found included ATM and PALB mutation carriers, Peutz-Jeghers syndrome, and Lynch Syndrome. Familial pancreatic cancer was diagnosed in three patients (8.6%). The BRCA2 mutation was the most common identifiable genetic factor (34.8%). The median follow-up time was 23 months (interquartile range 8-59 months). Regarding EUS findings, solid tumors were detected in three patients (8.6%) (two adenocarcinomas and one neuroendocrine tumor). In two patients (5.7%) branch-duct intraductal papillary mucinous neoplasm were observed. Other pancreatic abnormalities were detected in 18 patients (51.4%). Chronic pancreatitis-like parenchymal changes were found in nine patients (34.3%) that include non-shadowing hyperechoic strands (14.3%), small cysts (14.3%), and dilated side branches≥1 mm (5.7%). In two patients (5.7%), Rosemont criteria for chronic pancreatitis were met. The presence of peripancreatic lymph nodes and fatty pancreas was identified in two patients (5.7%) respectively. Finally, in 12 patients (34.3%), the endoscopic ultrasound was normal.

Conclusions In high-risk patients, endoscopic ultrasound detects neoplastic lesions at a high rate. Other findings, such as chronic pancreatitis-like parenchymal changes, peripancreatic lymph nodes, or fatty pancreas, were also common in this patient group.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Overbeek KA, Cahen DL, Bruno MJ.. The role of endoscopic ultrasound in the detection of pancreatic lesions in high-risk individuals. Familial Cancer 2024; 23: 279-293
• 2 Goggins M, Overbeek KA, Brand R, Syngal S, Del Chiaro M, Bartsch DK. et al. Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium. Gut 2020; 69: 7-17

Publication History

Article published online:
27 March 2025