title: Frequent detection of pancreatic lesions in asymptomatic high-risk individuals.
abstract: OBJECTIVE
  The risk of pancreatic cancer is increased in patients with a strong family history of pancreatic cancer or a predisposing germline mutation. Screening can detect curable, noninvasive pancreatic neoplasms, but the optimal imaging approach is not known. We determined the baseline prevalence and characteristics of pancreatic abnormalities using 3 imaging tests to screen asymptomatic, high-risk individuals (HRIs).
  
  
  METHODS
  We screened 225 asymptomatic adult HRIs at 5 academic US medical centers once, using computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasonography (EUS). We compared results in a blinded, independent fashion.
  
  
  RESULTS
  Ninety-two of 216 HRIs (42%) were found to have at least 1 pancreatic mass (84 cystic, 3 solid) or a dilated pancreatic duct (n = 5) by any of the imaging modalities. Fifty-one of the 84 HRIs with a cyst (60.7%) had multiple lesions, typically small (mean, 0.55 cm; range, 2-39 mm), in multiple locations. The prevalence of pancreatic lesions increased with age; they were detected in 14% of subjects younger than 50 years old, 34% of subjects 50-59 years old, and 53% of subjects 60-69 years old (P < .0001). CT, MRI, and EUS detected a pancreatic abnormality in 11%, 33.3%, and 42.6% of the HRIs, respectively. Among these abnormalities, proven or suspected neoplasms were identified in 85 HRIs (82 intraductal papillary mucinous neoplasms and 3 pancreatic endocrine tumors). Three of 5 HRIs who underwent pancreatic resection had high-grade dysplasia in less than 3 cm intraductal papillary mucinous neoplasms and in multiple intraepithelial neoplasias.
  
  
  CONCLUSIONS
  Screening of asymptomatic HRIs frequently detects small pancreatic cysts, including curable, noninvasive high-grade neoplasms. EUS and MRI detect pancreatic lesions better than CT.
authors.affiliation: Department of Medicine (Division of Gastroenterology), The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205, USA. mcanto@jhmi.edu
authors.forename: Marcia Irene
authors.initials: MI
authors.lastname: Canto
authors.forename: Ralph H
authors.initials: RH
authors.lastname: Hruban
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
authors.forename: Ihab R
authors.initials: IR
authors.lastname: Kamel
authors.forename: Richard
authors.initials: R
authors.lastname: Schulick
authors.forename: Zhe
authors.initials: Z
authors.lastname: Zhang
authors.forename: Mark
authors.initials: M
authors.lastname: Topazian
authors.forename: Naoki
authors.initials: N
authors.lastname: Takahashi
authors.forename: Joel
authors.initials: J
authors.lastname: Fletcher
authors.forename: Gloria
authors.initials: G
authors.lastname: Petersen
authors.forename: Alison P
authors.initials: AP
authors.lastname: Klein
authors.forename: Jennifer
authors.initials: J
authors.lastname: Axilbund
authors.forename: Constance
authors.initials: C
authors.lastname: Griffin
authors.forename: Sapna
authors.initials: S
authors.lastname: Syngal
authors.forename: John R
authors.initials: JR
authors.lastname: Saltzman
authors.forename: Koenraad J
authors.initials: KJ
authors.lastname: Mortele
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lee
authors.forename: Eric
authors.initials: E
authors.lastname: Tamm
authors.forename: Raghunandan
authors.initials: R
authors.lastname: Vikram
authors.forename: Priya
authors.initials: P
authors.lastname: Bhosale
authors.forename: Daniel
authors.initials: D
authors.lastname: Margolis
authors.forename: James
authors.initials: J
authors.lastname: Farrell
authors.forename: Michael
authors.initials: M
authors.lastname: Goggins
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D058070:Asymptomatic Diseases; D016009:Chi-Square Distribution; D003952:Diagnostic Imaging / Q000379:methods; D019160:Endosonography; D005260:Female; D020022:Genetic Predisposition to Disease; D040941:Heredity; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010181:Pancreatic Cyst / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics / Q000473:pathology / Q000601:surgery; D010375:Pedigree; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology