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MRI-based screening effective for pancreatic cancer detection
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MRI screening effectively detected pancreatic lesions in patients at an elevated risk for pancreatic cancer, according to results of a prospective observational study.
“Pancreatic cancer is the fourth leading cause of cancer-related death in the United States and many Western countries,” Marco Del Chiaro, MD, PhD, of the division of surgery at the Karolinska Institute in Sweden, and colleagues wrote. “Although treatment has improved, the resection rate in patients with ductal adenocarcinoma remains around 30% and the 5-year survival rate is less than 20%. Because of the low incidence rate of pancreatic cancer in the general population, population-based screening is not considered cost-effective.”
A specific pancreatic screening protocol has not been determined for individuals at higher risk due to genetics and/or family history, according to study background.
Del Chiaro and colleagues evaluated data from 40 Swedish individuals with an identified risk for pancreatic cancer. The mean age of the population was 49.9 years (range, 23-76) and 24 were women.
Enrolled participants had a 10-fold increased risk of developing pancreatic cancer compared with the general population due to a history of familial pancreatic cancer and genetic risk. The number of relatives with pancreatic cancer were five in two participants (5%), four in five participants (12.5%), three in 17 participants (42.5%), two in 14 participants (35%) and one in two participants (5%). Four participants (10%) harbored a p16 mutation, three participants (7.5%) harbored a BRCA2 mutation and one participant (2.5%) harbored a BRCA1 mutation.
Participants underwent an MRI/magnetic resonance cholangiopancreatography with secretin, and participants with negative MRI results underwent rescreening in 1 year. Surgery was recommended for patients with malignant lesions and endoscopic ultrasonography — with or without fine-needle aspiration and/or CT scanning — was recommended for patients with unspecific imaging or benign lesions.
Mean follow-up was 12.9 months.
The researchers identified pancreatic lesions in 40% (n = 16) of the study cohort. Fourteen of these lesions were intraductal papillary mucinous neoplasia and two were pancreatic ductal adenocarcinoma. One patient had a synchronous intraductal papillary mucinous neoplasia and pancreatic adenocarcinoma.
The median time to lesion detection was 6.2 months (range, 0-36 months) and 30% (n = 12) of individuals had lesions detected at point zero. Five patients (12.5%) underwent surgery to remove lesions during the course of the study, and the other 35 participants remain on surveillance.
Patients with positive lesions tended to be older than patients with negative lesions (58.6 years vs. 44.2 years, P < .001).
The researchers acknowledged the small patient cohort and divergent results may be limitations to these findings.
“An MRI-based protocol for the surveillance of individuals at risk for developing pancreatic cancers seems to detect cancer or premalignant lesions with good accuracy,” Del Chiaro and colleagues concluded. “The exclusive use of MRI can reduce costs, increase availability and guarantee the safety of the individuals under surveillance compared with protocols that are based on more aggressive methods.”
These data highlight the challenges when considering pancreatic cancer screening, Mark S. Talamonti, MD, of the department of surgery at NorthShore University HealthSystem, wrote in an accompanying editorial.
“Pancreatic cancer is diagnosed in only 10% of patients with syndromic risk factors or a family history of pancreatic cancer,” Talamonti wrote. “The other 90% are considered sporadic cancers with no currently known risk factors. And that is the real challenge for the future of early detection of pancreatic cancer. In current clinical practice, no biomarkers exist for diagnosing early-stage disease. Population screening with radiographic imaging or endoscopic procedures makes no clinical or economic sense for a cancer that represents only 3% of estimated new cancers each year; however, with an aging population, this most formidable of cancers will only increase in incidence and frequency. There is a clear and unequivocal need for affordable screening strategies based on reliable biomarkers and efficient imaging modalities.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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