Methods and outcomes of screening for pancreaticadenocarcinoma in high-risk individuals

• 作者: Gabriele Capurso Gianfranco Delle Fave Jan-Werner Poley Marco Del Chiaro Marianna Signoretti Matthias Lohr Roberto Valente Urban Arnelo
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: ENDOSCOPIC ULTRASOUND PANCREATIC cancer SCREENING HIGH-RISK individuals Magnetic resonance
• 年，卷（期）: 2015,（9）
• 页码范围: 833-842
• 页数: 10页
• 分类号: R

摘要

Pancreatic ductal adenocarcinoma （PDAC） is a lethalneoplasia, for which secondary prevention （i.e .,screening） is advisable for high-risk individuals with＂familiar pancreatic cancer＂ and with other specificgenetic syndromes （Peutz-Jeghers, p16, BRCA2, PALBand mismatch repair gene mutation carriers）. There islimited evidence regarding the accuracy of screeningtests, their acceptability, costs and availability, andagreement on whom to treat. Successful target ofscreening are small resectable PDAC, intraductalpapillary mucinous neoplasms with high-grade dysplasiaand advanced pancreatic intraepithelial neoplasia. Bothmagnetic resonance imaging （MRI） and endoscopicultrasound （EUS） are employed for screening, and theoverall yield for pre-malignant or malignant pancreaticlesions is of about 20% with EUS and 14% with MRI/magnetic resonance colangiopancreatography. EUSperforms better for solid and MRI for cystic lesions.However, only 2% of these detected lesions can beconsidered a successful target, and there are insufficientdata demonstrating that resection of benign or lowgrade lesions improves survival. Many patients in thepublished studies therefore seemed to have receivedan overtreatment by undergoing surgery. It is crucial tobetter stratify the risk of malignancy individually, and tobetter define optimal screening intervals and methodseither with computerized tools or molecular biomarkers,possibly in large multicentre studies. At the moment,screening should be carefully performed within researchprotocols at experienced centres, offering involvedindividuals medical and psychological advice.