Methods and outcomes of screening for pancreatic adenocarcinoma in high-risk individuals

Table 1 Summary of diagnostic yields of endoscopic ultrasound based protocols for familiar pancreatic cancer screening in high risk individuals

Ref.	Patients and syndrome	Diagnostic Yield1 of EUS	No. of solid lesions (mass or nodule)	No. of cystic lesions	No. with chronic pancreatitis features	No. with pre/malignant lesions suspected at baseline or FU	Number with histologically confirmed target lesions for which treatment can be considered a success2
Brentnall et al[16]	13 (FPC)	46.2%	-	-	10 (77%)	6 (46.2%)	?
Kimmey et al[17]	46 (FPC)	26%	-	-	24 (52.2%)	12 (26%)	?
Canto et al[18]	38 (FPC, PJS)	10.5%	12 (31.5%)	-	17 (44.7%)	6 (15.7%)	2/7 patients who underwent resection (1 PDAC, 1 PanIN3)
Canto et al[19]	78 (FPC, PJS)	10.2%	8 (10.2%)	9 (11.8%)	61 (78.2%)	8 (10.2%)	3/7 patients who underwent resection (1 IPMN+ca in situ, 1 IPMN + PanIN3, 1 PanIN3)
Poley et al[20]	44 (FPC, PJS, FAMM, FBOC, HP, LFS)	22.7%	3 (6.8%)	7 (16%)	3 (6.8%)	10 (22.7%)	3/3 patients who underwent resection (3 PDAC)
Langer et al[21]	76 (FPC, FAMM)	2.6%	7 (9.2%)	3 (3.9%)	17 (22.3%)	7 (11.8%)	0/7 patients who underwent resection
Verna et al[23]	31 (FPC, FBOC)	22.5%	2 (6.4)	12 (38.7)	9 (29%)	7 (22.6%)	1/5 who underwent surgery (1 PDAC)
Canto et al[24]	216 (FPC, FBOC, PJS)	37%	3 (1.4%)	79 (36%)	54 (25%)	79 (37%)	3/5 who underwent surgery (2 MD-IPMN, 1 BD-IPMN + panIN3)
Total	542	22.2%	35 (6.5%)	110 ( 20.3%)	195 (36%)	135 (25%)	12/542 (2.2%) of total

¹Endoscopic yield is defined as EUS detection of any lesions morphologically suspicious for BD-IPMN or histologically proven (pre) malignant lesion (PanIN ≥ 2, IPMN and pancreatic adenocarcinoma) at baseline evaluation and, when performed, during the follow up;

²Treatment is considered a success if any of the following lesions is found at surgery: resectable PDAC, MD-IPMN or IPMN with dysplasia, PanIN3. EUS: Endoscopic ultrasonography; FNA: Fine-needle aspiration; FPC: Familial pancreatic cancer; BD: Branch duct; MD: Main duct; IPMN: Intraductal papillary mucinous neoplasm; PDAC: Pancreatic ductal adenocarcinoma; PJS: Peutz–Jeghers syndrome; PanIN: Pancreatic intraepithelial neoplasia; FAMMM: Familial atypical multiple mole melanoma; FBOC: Familial breast ovarian cancer; HP: Hereditary pancreatitis; LFS: Li fraumeni syndrome.

Table 2 Summary of diagnostic yield of magnetic resonance imaging based protocols for familiar pancreatic cancer screening in high risk individuals

Ref.	Patients and syndrome	Diagnostic Yield1 of MRI	No. of solid lesions (mass or nodule)	No. of cystic lesions	No. with chronic pancreatitis features	No. with pre/malignant lesions suspected at baseline or FU	Number with histologically target lesions for which treatment has to be considered a success2
Langer et al[21]	76 (FAMMM, MPCS, FBOC)	23.3%	6 (7.8%)	2 (2.6%)	1 (1.3%)	12 (15%)	1/7 who underwent surgery (1 PDAC)
Vasen et al[27]	77 (FAMMM)	20.7%	7 (9%)	Not specified	9 (11.6%)	7 (9%)	4/5 who underwent surgery (4 R0 PDAC)
Ludwig et al[28]	109 (FPC)	16.5%	1 (0.9%)	Not specified	2 (1.8%)	18 (17.4%)	4/6 who underwent surgery (2 MD-IPMN, 1 PDAC, 1 PanIn3)
Canto et al[24]	216 (PJG, FPC, FBOC)	33.7%	1 (0.4%)	71 (32.8%)	-	45 (20.8%)	3/5 who underwent surgery (1 MD-IPMN + HGD, 1MD IPMN, 1 BD IPMN + PNET + HGD)
Al-Sukhni et al[25]	226 (PJG, FPC, FBOC, FAMMM, HP)	50.4%	2 (0.8%)	80 (35.3%)	25 (11%)	5 (2%)	1/4 who underwent surgery (1 PDAC)
Verna et al[23]	33 (FPC, FAMMM, FBOC, HNPCC)	3.3%	3 (9%)	7 (21.2%)	1 (3%)	5 (15%)	Not specified how may pathological reports had been previously described in MRI
Del Chiaro et al[30]	40 (FPC, BRAC 2, BRAC 1, FAMMM)	40%	3 (7.5%)	14 (35%)	-	4 (10%)	5/5 (3 PDAC: 1 of them T1N0M0, 1 developed on a synchronous BD-IPMN in FU; 2 intermediate grade dysplasia IPMN of which one mixed type and one branch duct )
Total	777	26.8%	23 (2.9%)	174 (22.39%)	38 (4.8%)	96 (12.35%)	18/777 (2.3%) of total

¹MRI yield is defined as detection of any lesions morphologically suspicious for BD-IPMN or histologically proven (pre) malignant lesion (PanIN ≥ 2, IPMN and pancreatic adenocarcinoma) at baseline evaluation and, when performed, during the follow up;

²Treatment is considered a success if any of the following lesions is found at surgery: resectable PDAC, MD-IPMN or IPMN with dysplasia, PanIN3. FPC: Familial pancreatic cancer; BD: Branch duct; MD: Main duct; IPMN: Intraductal papillary mucinous neoplasm; PDAC: Pancreatic ductal adenocarcinoma; PJS: Peutz–Jeghers syndrome; PanIN: Pancreatic intraepithelial neoplasia; FAMMM: Familial atypical multiple mole melanoma; FBOC: Familial breast ovarian cancer; HP: Hereditary pancreatitis.