The Yield of First-Time Endoscopic Ultrasonography in Screening Individuals at a High Risk of Developing Pancreatic Cancer
The Yield of First-Time Endoscopic Ultrasonography in Screening Individuals at a High Risk of Developing Pancreatic Cancer
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DOI：
10.1038/ajg.2009.276
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发表时间：
2009-09-01
影响因子：
9.8
通讯作者：
Bruno, M. J.
中科院分区：
文献类型：
--
作者：
Poley, J. W.;Kluijt, I.;Bruno, M. J.
目的：大约 10-15% 的胰腺癌 (PC) 可能是遗传性的。我们研究了使用超声内镜 (EUS) 筛查 PC 风险高的个体。本文介绍了首次EUS筛查结果。 方法：符合本研究筛查条件的人群为家族性胰腺癌（FPC）家族受影响个体的一级家庭成员、PC易发性遗传综合征的突变携带者、Peutz-Jeghers综合征个体以及具有聚集性的其他PC易发性遗传综合征的突变携带者（每个家族≥2例） 电脑的。所有个体均无症状且之前未接受过 EUS。 结果：44 名年龄 32-75 岁的个体（男/女 18/26）接受了 EUS 筛查。 13 例来自家族性非典型多痣黑色素瘤 (FAMMM) 家族，21 例患有 FPC，3 例被诊断为遗传性胰腺炎，2 例为 Peutz-Jeghers 患者，3 例为 BRCA1 突变携带者，2 例为 BRCA2 突变携带者，伴有 PC 家族聚集，1 例为 p53 突变。三名 (6.8%) 患者在胰体 (n = 2) 或尾部有无症状肿块病变 (12、27 和 50 mm)。所有病灶均被完全切除。病理显示，病灶最大的两名患者为中分化腺癌，伴有 N1 期病变。 EUS 显示 7 名个体存在分支型导管内乳头状粘液性肿瘤 (IPMN)。 结论：用 EUS 筛查 PC 高风险个体是可行且安全的。在我们的系列中，首次筛查时临床相关发现的发生率很高，其中无症状癌症为 7%，癌前 IPMN 样病变为 16%。筛查是否可以提高生存率还有待确定，EUS 的最佳筛查间隔也是如此。
OBJECTIVES: Approximately 10-15% of all pancreatic cancers (PCs) may be hereditary in origin. We investigated the use of endoscopic ultrasonography (EUS) for the screening of individuals at high risk for developing PC. In this paper the results of first-time screening with EUS are presented.METHODS: Those eligible for screening in this study were first-degree family members of affected individuals from familial pancreatic cancer (FPC) families, mutation carriers of PC-prone hereditary syndromes, individuals with Peutz-Jeghers syndrome, and mutation carriers of other PC-prone hereditary syndromes with clustering (>= 2 cases per family) of PC. All individuals were asymptomatic and had not undergone EUS before.RESULTS: Forty-four individuals (M/F 18/26), aged 32-75 years underwent screening with EUS. Thirteen were from families with familial atypical multiple-mole melanoma (FAMMM), 21 with FPC, 3 individuals were diagnosed with hereditary pancreatitis, 2 were Peutz-Jeghers patients, 3 were BRCA1 and 2 were BRCA2 mutation carriers with familial clustering of PC, and 1 individual had a p53 mutation. Three (6.8%) patients had an asymptomatic mass lesion (12, 27, and 50 mm) in the body (n = 2) or tail of the pancreas. All lesions were completely resected. Pathology showed moderately differentiated adenocarcinomas with N1 disease in the two patients with the largest lesions. EUS showed branch-type intraductal papillary mucinous neoplasia (IPMN) in seven individuals.CONCLUSIONS: Screening of individuals at a high risk for PC with EUS is feasible and safe. The incidence of clinically relevant findings at first screening is high with asymptomatic cancer in 7% and premalignant IPMN-like lesions in 16% in our series. Whether screening improves survival remains to be determined, as does the optimal screening interval with EUS.