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World J Gastroenterol. Sep 7, 2012; 18(33): 4474-4477
Published online Sep 7, 2012. doi: 10.3748/wjg.v18.i33.4474
Asymptomatic pancreatic lesions: New insights and clinical implications
Martin Loos, Christoph W Michalski, Jörg Kleeff
Martin Loos, Christoph W Michalski, Jörg Kleeff, Department of Surgery, Klinikum rechts der Isar, Technische Universität München, 81675 München, Germany
Author contributions: All authors collected the material; Loos M drafted the article; Michalski CW and Kleeff J critically revised the article for important intellectual content; and all authors approved the final version of the manuscript.
Correspondence to: Jörg Kleeff, MD, AGAF, FACS, Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 München, Germany. kleeff@tum.de
Telephone: +49-89-41405098 Fax: +49-89-41404870
Received: June 5, 2012
Revised: July 3, 2012
Accepted: August 15, 2012
Published online: September 7, 2012
Abstract

Despite great efforts in experimental and clinical research, the prognosis of pancreatic cancer (PC) has not changed significantly for decades. Detection of pre-invasive lesions or early-stage PC with small resectable cancers in asymptomatic individuals remains one of the most promising approaches to substantially improve the overall outcome of PC. Therefore, screening programs have been proposed to identify curable lesions especially in individuals with a familial or genetic predisposition for PC. In this regard, Canto et al recently contributed an important article comparing computed tomography, magnetic resonance imaging, and endoscopic ultrasound for the screening of 216 asymptomatic high-risk individuals (HRI). Pancreatic lesions were detected in 92 of 216 asymptomatic HRI (42.6%). The high diagnostic yield in this study raises several questions that need to be answered of which two will be discussed in detail in this commentary: First: which imaging test should be performed? Second and most importantly: what are we doing with incidentally detected pancreatic lesions? Which ones can be observed and which ones need to be resected?

Keywords: Pancreatic cancer; Early-stage pancreatic cancer; Asymptomatic high-risk individuals; Pre-invasive pancreatic lesions; Cystic pancreatic tumors; Screening; Computed tomography; Magnetic resonance imaging; Endoscopic ultrasound