Pancreatic Findings by Germline Mutation Status and Imaging Modality in Patients Undergoing Screening for PDAC

An estimated 10-15% of pancreatic ductal adenocarcinomas (PDAC) cases are attributable to genetic causes or are identified in patients with family history. Endoscopic Ultrasound (EUS) and Magnetic Resonance Imaging (MRI) are most sensitive modalities for screening in these high-risk individuals. Our goal was to identify the most common pancreatic EUS abnormalities in patients across genetic and familial risk factors and compare the prevalence of these findings in different mutation carriers at baseline and during surveillance. Our study is one of the largest to describe in detail pancreatic EUS and MRI findings by germline mutational status. Overall, nearly two-third and half of patients with FHPC and PGV respectively had abnormal EUS or MRI imaging. Though BRCA genes were associated with lower risk of pancreatic abnormalities at baseline, this lower risk was not sustained in surveillance imaging. We did not find significant differences in the pattern of abnormalities between PGV carriers and those without a genetic mutation. However, our results show that progressive parenchymal changes are common in both PGV and FHPC and perhaps especially prevalent in those with MMR mutations. Our results provide a baseline for expectation of imaging findings, which we believe is important as the number of patients undergoing pancreatic cancer screening is expanding.