Outcomes of pancreatic cancer surveillance among high-risk individuals at a tertiary care academic center

Abstract

Background: Pancreatic cancer screening is only recommended for those with a strong family history or predisposing hereditary pathogenic variant. For these high-risk individuals (HRIs), practice guidelines recommend annual pancreas surveillance by either endoscopic ultrasound (EUS) or magnetic resonance imaging (MRI). We report HRI surveillance outcomes and tested the hypothesis that HRIs would have substantially more non-malignant pancreatic changes than non-HRIs.

Methods: HRIs were included if they met high-risk criteria per major practice guidelines and underwent at least one screening exam. Non-HRI controls were identified as patients undergoing EUS for non-pancreatic indications. Patients' demographic and clinical data including surveillance findings were obtained retrospectively from electronic health records.

Results: 278 HRIs were followed for a total of 1454 person-years from 2009 through 2024. During this period, 3 (1.1%) patients were diagnosed with pancreatic ductal adenocarcinoma (PDAC) at stages IA (n = 1) and IV (n = 2), and 2 (0.7%) with high-grade dysplasia (HGD). In a multivariable analysis, HRIs were significantly more likely than non-HRI controls to have incidental non-malignant findings of diffuse echogenicity [OR 3.3, 95% CI (1.5-7.5)], hyperechoic stranding [OR 20.2, 95% CI (7.3-55.8)], hyperechoic foci [OR 37.6, 95% CI (4.9-289.5)], lobularity [OR 9.1, 95% CI (3.8-22.0)], and cysts [OR 63.4, 95% CI (8.2-488.6)] on EUS.

Conclusions: The results highlight the need for cascade genetic testing to identify asymptomatic relatives who carry an identified familial pathogenic variant that confers high pancreatic cancer risk. Further studies are needed to determine the relationship between non-malignant EUS findings and development of PDAC or HGD.

Keywords: High-risk individuals; Pancreatic cancer screening; Surveillance outcomes.