Screening for early pancreatic neoplasia in high-risk individuals: A prospective controlled study
Screening for early pancreatic neoplasia in high-risk individuals: A prospective controlled study
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DOI：
10.1016/j.cgh.2006.02.005
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发表时间：
2006-06-01
影响因子：
12.6
通讯作者：
Kalloo, Anthony N.
中科院分区：
文献类型：
--
作者：
Canto, Marcia Irene;Goggins, Michael;Kalloo, Anthony N.
背景与目的：有胰腺癌家族史的个体和Peutz-Jeghers综合征(PJS)患者患胰腺癌的风险增加。这项研究筛选早期胰腺肿瘤，并比较高危个体和对照受试者的胰腺异常。方法：对有PJS或有胰腺癌家族史的高危个体进行前瞻性评估，包括基线扫描和12个月的CT扫描和超声内窥镜检查。如果EUS异常，则行EUS细针吸取和内窥镜逆行胰胆管造影术(ERCP)。手术被提供给有潜在肿瘤性损害的患者。将影像表现与病理诊断进行对照。同时接受EUS和/或ERCP治疗良性非胰腺指征的患者作为对照。结果：78例高危患者(72例来自家族性胰腺癌家族，6例PJS)和149例对照患者进入研究。到目前为止，已有8例胰腺肿瘤患者经手术或细针抽吸证实(筛查率为10%)，6例良性导管内乳头状黏液性肿瘤(IPMN)，1例IPMN进展为浸润性导管腺癌，1例胰腺上皮内肿瘤。EUS和CT还诊断了3例5个胰腺外肿瘤。在EUS和ERCP中，提示慢性胰腺炎的异常在高危患者中比对照组更常见。结论：筛查EUS和CT在高危个体中诊断为显著的无症状胰腺和胰外肿瘤。IPMN应视为家族性胰腺癌表型的一部分。提示慢性胰腺炎的异常更常见于高危个体的EUS和ERCP。
Background & Aims: Individuals with a strong family history of pancreatic cancer and persons with Peutz-Jeghers syndrome (PJS) have an increased risk for pancreatic cancer. This study screened for early pancreatic neoplasia and compared the pancreatic abnormalities in high-risk individuals and control subjects. Methods: High-risk individuals with PJS or a strong family history of pancreatic cancer were prospectively evaluated with baseline and 12-month computed tomography (CT) scan and endoscopic ultrasonography (EUS). If EUS was abnormal, EUS-fine-needle aspiration and endoscopic retrograde cholangiopancreatography (ERCP) were performed. Surgery was offered to patients with potentially neoplastic lesions. Radiologic findings and pathologic diagnoses were compared. Patients undergoing EUS and/or ERCP for benign non-pancreatic indications were concurrently enrolled as control subjects. Results: Seventy-eight high-risk patients (72 from familial pancreatic cancer kindreds, 6 PJS) and 149 control patients were studied. To date, 8 patients with pancreatic neoplasia have been confirmed by surgery or fine-needle aspiration (10% yield of screening); 6 patients had 8 benign intraductal papillary mucinous neoplasms (IPMNs), 1 had an IPMN that progressed to invasive ductal adenocarcinoma, and 1 had pancreatic intraepithelial neoplasia. EUS and CT also diagnosed 3 patients with 5 extrapancreatic neoplasms. At EUS and ERCP abnormalities suggestive of chronic pancreatitis were more common in high-risk patients than in control subjects. Conclusions: Screening EUS and CT diagnosed significant asymptomatic pancreatic and extrapancreatic neoplasms in high-risk individuals. IPMN should be considered a part of the phenotype of familial pancreatic cancer. Abnormalities suggestive of chronic pancreatitis are identified more commonly at EUS and ERCP in high-risk individuals.