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Results of First-Round of Surveillance in Individuals at High-Risk of Pancreatic Cancer from the AISP (Italian Association for the Study of the Pancreas) Registry

Paiella, Salvatore, MD1; Capurso, Gabriele, MD, PhD2; Cavestro, Giulia Martina, MD, PhD3; Butturini, Giovanni, MD, PhD4; Pezzilli, Raffaele, MD, PhD5; Salvia, Roberto, MD, PhD1; Signoretti, Marianna, MD2; Crippa, Stefano, MD, PhD6; Carrara, Silvia, MD7; Frigerio, Isabella, MD, PhD4; Bassi, Claudio, MD, FACS, FEBS, FRCS, FASA (Hon.)1; Falconi, Massimo, MD6; Iannicelli, Elsa, MD8; Giardino, Alessandro, MD, PhD4; Mannucci, Alessandro, MD3; Laghi, Andrea, MD, PhD8; Laghi, Luigi, MD, PhD9; Frulloni, Luca, MD, PhD10; Zerbi, Alessandro, MD, PhD11

American Journal of Gastroenterology: April 2019 - Volume 114 - Issue 4 - p 665–670
doi: 10.1038/s41395-018-0414-z
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INTRODUCTION: Surveillance programs on high-risk individuals (HRIs) can detect pre-malignant lesions or early pancreatic cancer (PC). We report the results of the first screening round of the Italian multicenter program supported by the Italian Association for the study of the Pancreas (AISP).

METHODS: The multicenter surveillance program included asymptomatic HRIs with familial (FPC) or genetic frailty (GS: BRCA1/2, p16/CDKN2A, STK11/LKB1or PRSS1, mutated genes) predisposition to PC. The surveillance program included at least an annual magnetic resonance cholangio pancreatography (MRCP). Endoscopic ultrasound (EUS) was proposed to patients who refused or could not be submitted to MRCP.

RESULTS: One-hundreds eighty-seven HRIs underwent a first-round screening examination with MRCP (174; 93.1%) or EUS (13; 6.9%) from September 2015 to March 2018.The mean age was 51 years (range 21–80).One-hundreds sixty-five (88.2%) FPC and 22 (11.8%) GF HRIs were included. MRCP detected 28 (14.9%) presumed branch-duct intraductal papillary mucinous neoplasms (IPMN), 1 invasive carcinoma/IPMN and one low-grade mixed-type IPMN, respectively. EUS detected 4 PC (2.1%): 1 was resected, 1 was found locally advanced intraoperatively, and 2 were metastatic. Age > 50 (OR 3.3, 95%CI 1.4–8), smoking habit (OR 2.8, 95%CI 1.1–7.5), and having > 2 relatives with PC (OR 2.7, 95%CI 1.1–6.4) were independently associated with detection of pre-malignant and malignant lesions. The diagnostic yield for MRCP/EUS was 24% for cystic lesions. The overall rate of surgery was 2.6% with nil mortality.

DISCUSSION: The rate of malignancies found in this cohort was high (2.6%). According to the International Cancer of the Pancreas Screening Consortium the screening goal achievement was high (1%).

1General and Pancreatic Surgery Department, Pancreas Institute, University of Verona, Verona, Italy;

2Digestive and Liver Disease Unit, S. Andrea Hospital, University Sapienza, Rome, Italy;

3Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS Ospedale San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy;

4Pancreatic Surgery Unit, Casa di Cura Pederzoli Hospital, Peschiera del Garda, Italy;

5Internal Medicine, University of Bologna, Bologna, Italy;

6Pancreatic Surgery Unit, IRCCS Ospedale San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milano, Italy;

7Gastrointestinal Endoscopy, Istituto Clinico Humanitas, Milano, Italy;

8Radiology Unit, S. Andrea Hospital, University Sapienza, Rome, Italy;

9Hereditary Cancer Genetics Clinic, Humanitas Clinical and Research Center, Milano, Italy;

10Gastroenterology B Unit, Pancreas Institute, University of Verona, Verona, Italy;

11Pancreatic Surgery Unit, Humanitas Clinical and Research Center, Milano, Italy.

Correspondence: Salvatore Paiella, MD. E-mail: salvatore.paiella@univr.it.

Received June 20, 2018

Accepted October 05, 2018

© The American College of Gastroenterology 2019. All Rights Reserved.
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