Timeline of Development of Pancreatic Cancer and Implications for Successful Early Detection in High-Risk Individuals
To successfully implement imaging-based pancreatic cancer (PC) surveillance, understanding the timeline and morphologic features of neoplastic progression is key. We aimed to investigate the progression to neoplasia from serial prediagnostic pancreatic imaging tests in high-risk individuals and iden...
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| Veröffentlicht in: | Gastroenterology (New York, N.Y. 1943) N.Y. 1943), 2022-03, Vol.162 (3), p.772-785.e4 |
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| creator | Overbeek, Kasper A. Goggins, Michael G. Dbouk, Mohamad Levink, Iris J.M. Koopmann, Brechtje D.M. Chuidian, Miguel Konings, Ingrid C.A.W. Paiella, Salvatore Earl, Julie Fockens, Paul Gress, Thomas M. Ausems, Margreet G.E.M. Poley, Jan-Werner Thosani, Nirav C. Half, Elizabeth Lachter, Jesse Stoffel, Elena M. Kwon, Richard S. Stoita, Alina Kastrinos, Fay Lucas, Aimee L. Syngal, Sapna Brand, Randall E. Chak, Amitabh Carrato, Alfredo Vleggaar, Frank P. Bartsch, Detlef K. van Hooft, Jeanin E. Cahen, Djuna L. Canto, Marcia Irene Bruno, Marco J. |
| description | To successfully implement imaging-based pancreatic cancer (PC) surveillance, understanding the timeline and morphologic features of neoplastic progression is key. We aimed to investigate the progression to neoplasia from serial prediagnostic pancreatic imaging tests in high-risk individuals and identify factors associated with successful early detection.
We retrospectively examined the development of pancreatic abnormalities in high-risk individuals who were diagnosed with PC or underwent pancreatic surgery, or both, in 16 international surveillance programs.
Of 2552 high-risk individuals under surveillance, 28 (1%) developed neoplastic progression to PC or high-grade dysplasia during a median follow-up of 29 months after baseline (interquartile range [IQR], 40 months). Of these, 13 of 28 (46%) presented with a new lesion (median size, 15 mm; range 7–57 mm), a median of 11 months (IQR, 8; range 3–17 months) after a prior examination, by which time 10 of 13 (77%) had progressed beyond the pancreas. The remaining 15 of 28 (54%) had neoplastic progression in a previously detected lesion (12 originally cystic, 2 indeterminate, 1 solid), and 11 (73%) had PC progressed beyond the pancreas. The 12 patients with cysts had been monitored for 21 months (IQR, 15 months) and had a median growth of 5 mm/y (IQR, 8 mm/y). Successful early detection (as high-grade dysplasia or PC confined to the pancreas) was associated with resection of cystic lesions (vs solid or indeterminate lesions (odds ratio, 5.388; 95% confidence interval, 1.525–19.029) and small lesions (odds ratio, 0.890/mm; 95% confidence interval 0.812–0.976/mm).
In nearly half of high-risk individuals developing high-grade dysplasia or PC, no prior lesions are detected by imaging, yet they present at an advanced stage. Progression can occur before the next scheduled annual examination. More sensitive diagnostic tools or a different management strategy for rapidly growing cysts are needed.
Almost half of pancreatic cancers develop rapidly and without warning signs on scans or endoscopy. The other half grow from earlier visible pancreatic cysts, which are difficult to discern from innocent cysts. |
| doi_str_mv | 10.1053/j.gastro.2021.10.014 |
| format | Article |
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We retrospectively examined the development of pancreatic abnormalities in high-risk individuals who were diagnosed with PC or underwent pancreatic surgery, or both, in 16 international surveillance programs.
Of 2552 high-risk individuals under surveillance, 28 (1%) developed neoplastic progression to PC or high-grade dysplasia during a median follow-up of 29 months after baseline (interquartile range [IQR], 40 months). Of these, 13 of 28 (46%) presented with a new lesion (median size, 15 mm; range 7–57 mm), a median of 11 months (IQR, 8; range 3–17 months) after a prior examination, by which time 10 of 13 (77%) had progressed beyond the pancreas. The remaining 15 of 28 (54%) had neoplastic progression in a previously detected lesion (12 originally cystic, 2 indeterminate, 1 solid), and 11 (73%) had PC progressed beyond the pancreas. The 12 patients with cysts had been monitored for 21 months (IQR, 15 months) and had a median growth of 5 mm/y (IQR, 8 mm/y). Successful early detection (as high-grade dysplasia or PC confined to the pancreas) was associated with resection of cystic lesions (vs solid or indeterminate lesions (odds ratio, 5.388; 95% confidence interval, 1.525–19.029) and small lesions (odds ratio, 0.890/mm; 95% confidence interval 0.812–0.976/mm).
In nearly half of high-risk individuals developing high-grade dysplasia or PC, no prior lesions are detected by imaging, yet they present at an advanced stage. Progression can occur before the next scheduled annual examination. More sensitive diagnostic tools or a different management strategy for rapidly growing cysts are needed.
Almost half of pancreatic cancers develop rapidly and without warning signs on scans or endoscopy. The other half grow from earlier visible pancreatic cysts, which are difficult to discern from innocent cysts.</description><identifier>ISSN: 0016-5085</identifier><identifier>EISSN: 1528-0012</identifier><identifier>DOI: 10.1053/j.gastro.2021.10.014</identifier><identifier>PMID: 34678218</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Disease Progression ; Early Detection of Cancer ; Endosonography ; Familial Pancreatic Cancer ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Metastasis ; Pancreas - pathology ; Pancreatic Cancer ; Pancreatic Cyst - diagnostic imaging ; Pancreatic Cyst - pathology ; Pancreatic Neoplasms - diagnostic imaging ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - surgery ; Precancerous Conditions - diagnostic imaging ; Precancerous Conditions - pathology ; Retrospective Studies ; Risk Factors ; Screening ; Surveillance ; Time Factors ; Tomography, X-Ray Computed ; Tumor Burden ; Watchful Waiting</subject><ispartof>Gastroenterology (New York, N.Y. 1943), 2022-03, Vol.162 (3), p.772-785.e4</ispartof><rights>2022 The Authors</rights><rights>Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c408t-624034cff4a96a96954b318848e2bdc4c0a47e7fa2155280e32337c8cfef93ed3</citedby><cites>FETCH-LOGICAL-c408t-624034cff4a96a96954b318848e2bdc4c0a47e7fa2155280e32337c8cfef93ed3</cites><orcidid>0000-0003-1829-9963</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0016508521036519$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34678218$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Overbeek, Kasper A.</creatorcontrib><creatorcontrib>Goggins, Michael G.</creatorcontrib><creatorcontrib>Dbouk, Mohamad</creatorcontrib><creatorcontrib>Levink, Iris J.M.</creatorcontrib><creatorcontrib>Koopmann, Brechtje D.M.</creatorcontrib><creatorcontrib>Chuidian, Miguel</creatorcontrib><creatorcontrib>Konings, Ingrid C.A.W.</creatorcontrib><creatorcontrib>Paiella, Salvatore</creatorcontrib><creatorcontrib>Earl, Julie</creatorcontrib><creatorcontrib>Fockens, Paul</creatorcontrib><creatorcontrib>Gress, Thomas M.</creatorcontrib><creatorcontrib>Ausems, Margreet G.E.M.</creatorcontrib><creatorcontrib>Poley, Jan-Werner</creatorcontrib><creatorcontrib>Thosani, Nirav C.</creatorcontrib><creatorcontrib>Half, Elizabeth</creatorcontrib><creatorcontrib>Lachter, Jesse</creatorcontrib><creatorcontrib>Stoffel, Elena M.</creatorcontrib><creatorcontrib>Kwon, Richard S.</creatorcontrib><creatorcontrib>Stoita, Alina</creatorcontrib><creatorcontrib>Kastrinos, Fay</creatorcontrib><creatorcontrib>Lucas, Aimee L.</creatorcontrib><creatorcontrib>Syngal, Sapna</creatorcontrib><creatorcontrib>Brand, Randall E.</creatorcontrib><creatorcontrib>Chak, Amitabh</creatorcontrib><creatorcontrib>Carrato, Alfredo</creatorcontrib><creatorcontrib>Vleggaar, Frank P.</creatorcontrib><creatorcontrib>Bartsch, Detlef K.</creatorcontrib><creatorcontrib>van Hooft, Jeanin E.</creatorcontrib><creatorcontrib>Cahen, Djuna L.</creatorcontrib><creatorcontrib>Canto, Marcia Irene</creatorcontrib><creatorcontrib>Bruno, Marco J.</creatorcontrib><creatorcontrib>International Cancer of the Pancreas Screening Consortium</creatorcontrib><title>Timeline of Development of Pancreatic Cancer and Implications for Successful Early Detection in High-Risk Individuals</title><title>Gastroenterology (New York, N.Y. 1943)</title><addtitle>Gastroenterology</addtitle><description>To successfully implement imaging-based pancreatic cancer (PC) surveillance, understanding the timeline and morphologic features of neoplastic progression is key. We aimed to investigate the progression to neoplasia from serial prediagnostic pancreatic imaging tests in high-risk individuals and identify factors associated with successful early detection.
We retrospectively examined the development of pancreatic abnormalities in high-risk individuals who were diagnosed with PC or underwent pancreatic surgery, or both, in 16 international surveillance programs.
Of 2552 high-risk individuals under surveillance, 28 (1%) developed neoplastic progression to PC or high-grade dysplasia during a median follow-up of 29 months after baseline (interquartile range [IQR], 40 months). Of these, 13 of 28 (46%) presented with a new lesion (median size, 15 mm; range 7–57 mm), a median of 11 months (IQR, 8; range 3–17 months) after a prior examination, by which time 10 of 13 (77%) had progressed beyond the pancreas. The remaining 15 of 28 (54%) had neoplastic progression in a previously detected lesion (12 originally cystic, 2 indeterminate, 1 solid), and 11 (73%) had PC progressed beyond the pancreas. The 12 patients with cysts had been monitored for 21 months (IQR, 15 months) and had a median growth of 5 mm/y (IQR, 8 mm/y). Successful early detection (as high-grade dysplasia or PC confined to the pancreas) was associated with resection of cystic lesions (vs solid or indeterminate lesions (odds ratio, 5.388; 95% confidence interval, 1.525–19.029) and small lesions (odds ratio, 0.890/mm; 95% confidence interval 0.812–0.976/mm).
In nearly half of high-risk individuals developing high-grade dysplasia or PC, no prior lesions are detected by imaging, yet they present at an advanced stage. Progression can occur before the next scheduled annual examination. More sensitive diagnostic tools or a different management strategy for rapidly growing cysts are needed.
Almost half of pancreatic cancers develop rapidly and without warning signs on scans or endoscopy. The other half grow from earlier visible pancreatic cysts, which are difficult to discern from innocent cysts.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Disease Progression</subject><subject>Early Detection of Cancer</subject><subject>Endosonography</subject><subject>Familial Pancreatic Cancer</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Metastasis</subject><subject>Pancreas - pathology</subject><subject>Pancreatic Cancer</subject><subject>Pancreatic Cyst - diagnostic imaging</subject><subject>Pancreatic Cyst - pathology</subject><subject>Pancreatic Neoplasms - diagnostic imaging</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Precancerous Conditions - diagnostic imaging</subject><subject>Precancerous Conditions - 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We aimed to investigate the progression to neoplasia from serial prediagnostic pancreatic imaging tests in high-risk individuals and identify factors associated with successful early detection.
We retrospectively examined the development of pancreatic abnormalities in high-risk individuals who were diagnosed with PC or underwent pancreatic surgery, or both, in 16 international surveillance programs.
Of 2552 high-risk individuals under surveillance, 28 (1%) developed neoplastic progression to PC or high-grade dysplasia during a median follow-up of 29 months after baseline (interquartile range [IQR], 40 months). Of these, 13 of 28 (46%) presented with a new lesion (median size, 15 mm; range 7–57 mm), a median of 11 months (IQR, 8; range 3–17 months) after a prior examination, by which time 10 of 13 (77%) had progressed beyond the pancreas. The remaining 15 of 28 (54%) had neoplastic progression in a previously detected lesion (12 originally cystic, 2 indeterminate, 1 solid), and 11 (73%) had PC progressed beyond the pancreas. The 12 patients with cysts had been monitored for 21 months (IQR, 15 months) and had a median growth of 5 mm/y (IQR, 8 mm/y). Successful early detection (as high-grade dysplasia or PC confined to the pancreas) was associated with resection of cystic lesions (vs solid or indeterminate lesions (odds ratio, 5.388; 95% confidence interval, 1.525–19.029) and small lesions (odds ratio, 0.890/mm; 95% confidence interval 0.812–0.976/mm).
In nearly half of high-risk individuals developing high-grade dysplasia or PC, no prior lesions are detected by imaging, yet they present at an advanced stage. Progression can occur before the next scheduled annual examination. More sensitive diagnostic tools or a different management strategy for rapidly growing cysts are needed.
Almost half of pancreatic cancers develop rapidly and without warning signs on scans or endoscopy. The other half grow from earlier visible pancreatic cysts, which are difficult to discern from innocent cysts.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34678218</pmid><doi>10.1053/j.gastro.2021.10.014</doi><orcidid>https://orcid.org/0000-0003-1829-9963</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Gastroenterology (New York, N.Y. 1943), 2022-03, Vol.162 (3), p.772-785.e4 |
| issn | 0016-5085 1528-0012 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2584802858 |
| source | MEDLINE; Elsevier ScienceDirect Journals; Alma/SFX Local Collection |
| subjects | Adult Aged Aged, 80 and over Disease Progression Early Detection of Cancer Endosonography Familial Pancreatic Cancer Female Follow-Up Studies Humans Magnetic Resonance Imaging Male Middle Aged Neoplasm Metastasis Pancreas - pathology Pancreatic Cancer Pancreatic Cyst - diagnostic imaging Pancreatic Cyst - pathology Pancreatic Neoplasms - diagnostic imaging Pancreatic Neoplasms - pathology Pancreatic Neoplasms - surgery Precancerous Conditions - diagnostic imaging Precancerous Conditions - pathology Retrospective Studies Risk Factors Screening Surveillance Time Factors Tomography, X-Ray Computed Tumor Burden Watchful Waiting |
| title | Timeline of Development of Pancreatic Cancer and Implications for Successful Early Detection in High-Risk Individuals |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-02T00%3A00%3A14IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Timeline%20of%20Development%20of%20Pancreatic%20Cancer%20and%20Implications%20for%20Successful%20Early%20Detection%20in%20High-Risk%20Individuals&rft.jtitle=Gastroenterology%20(New%20York,%20N.Y.%201943)&rft.au=Overbeek,%20Kasper%20A.&rft.aucorp=International%20Cancer%20of%20the%20Pancreas%20Screening%20Consortium&rft.date=2022-03&rft.volume=162&rft.issue=3&rft.spage=772&rft.epage=785.e4&rft.pages=772-785.e4&rft.issn=0016-5085&rft.eissn=1528-0012&rft_id=info:doi/10.1053/j.gastro.2021.10.014&rft_dat=%3Cproquest_cross%3E2584802858%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2584802858&rft_id=info:pmid/34678218&rft_els_id=S0016508521036519&rfr_iscdi=true |