Published online Sep 14, 2019. doi: 10.3748/wjg.v25.i34.5082
Peer-review started: June 5, 2019
First decision: July 21, 2019
Revised: August 4, 2019
Accepted: August 24, 2019
Article in press: August 24, 2019
Published online: September 14, 2019
Managing familial pancreatic cancer (FPC) is challenging for gastroenterologists, surgeons and oncologists. High-risk individuals (HRI) for pancreatic cancer (PC) (FPC or with germline mutations) are a heterogeneous group of subjects with a theoretical lifetime cumulative risk of PC over 5%. Screening is mainly based on annual magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS). The goal of screening is to identify early-stage operable cancers or high-risk precancerous lesions (pancreatic intraepithelial neoplasia or intraductal papillary mucinous neoplasms with high-grade dysplasia). In the literature, target lesions are identified in 2%-5% of HRI who undergo screening. EUS appears to provide better identification of small solid lesions (0%-46% of HRI) and chronic-pancreatitis-like parenchymal changes (14%-77% of HRI), while MRI is probably the best modality to identify small cystic lesions (13%-49% of HRI). There are no specific studies in HRI on the use of contrast-enhanced harmonic EUS. EUS can also be used to obtain tissue samples. Nevertheless, there is still limited evidence on the accuracy of imaging procedures used for screening or agreement on which patients to treat. The cost-effectiveness of screening is also unclear. Certain new EUS-related techniques, such as searching for DNA abnormalities or protein markers in pancreatic fluid, appear to be promising.
Core tip: High-risk individuals (HRI) for pancreatic cancer have a lifetime cumulative risk of this disorder of over 5%. The goal of screening is to identify operable cancers or precancerous lesions. Endoscopic ultrasound (EUS) appears to better identify solid lesions (0%-46% of HRI) and chronic-pancreatitis-like parenchymal changes (14%-77%), and magnetic resonance imaging to better identify small cysts (13%-49%). EUS is used to obtain tissue samples. There are no specific studies on contrast-enhanced harmonic EUS in HRI. There is limited evidence on the accuracy of imaging used for screening or agreement on which patients to treat. The cost-effectiveness of screening is also unclear. New EUS-related techniques (identifying DNA abnormalities or protein markers) appear to be promising.