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SURVEILLANCE FOR PANCREATIC CANCER IN HIGH-RISK INDIVIDUALS: FIRST-ROUND SCREENING RESULTS OF A MULTICENTRIC ITALIAN PROGRAM
Salvatore Paiella*1, Gabriele Capurso2, Giovanni Butturini3, Claudio Bassi1, Marianna Signoretti2, Isabella M. Frigerio3, Massimo Falconi5, Alessandro Zerbi4
1General and Pancreatic Surgery Department, Pancreas Institute, Verona, Italy; 2Digestive and Liver Disease Unit Pancreatic Disorders Clinic, S. Andrea Hospital, University Sapienza, Rome, Italy; 3HPB Unit, Pederzoli Clinic, Peschiera del Garda, Italy; 4Pancreatic Surgery Unit, Humanitas Research Hospital, Rozzano, Italy; 5Pancreatic surgery Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
BACKGROUND
Surveillance programs on high-risk individuals (HRI) proved to be able to detect premalignant lesions or early pancreatic adenocarcinoma (PDAC). We report the results of the first-round of screening of the Italian multicentric surveillance program.
METHODS
The multicentric surveillance program includes: a) individuals with familial pancreatic cancer (FPC) defined as these with ≥ 3 first-, second- or third-degree relatives with PDAC or individuals with 2 relatives with PDAC with at least 1 first-degree relative; b) BRCA 1/2 or p16 mutation carriers with at least 1 first- or second-degree relative diagnosed with PDAC; subjects suffering from hereditary pancreatitis or Peutz-Jegher syndrome. The surveillance program consists of an annual magnetic resonance cholangiopancreatography (MRCP).
RESULTS
Fifty-four subjects were enrolled from September 2015 to November 2016. The mean age was 48 years (range 26-79). Forty-eight (88.9%) FPC, 5 syndromic HRI (9.2%) and 1 (1.9%) hereditary pancreatitis were included. MRCP detected pancreatic cystic lesions in 7 HRI (13%, all FPC-HRI) and features of chronic pancreatitis (confirmed by Endoultrasonography) in 1 (1.9%). All cystic lesions were BD-IPMNs, 2 of them being multifocal. The mean diameter was 8.5 mm (range 4-16). No further diagnostic tests were performed to characterize BD-IPMNs since they did not show worrisome features nor high-risk stigmata. No solid lesions were identified. Interestingly, 2 migration anomalies (annular pancreas) and 2 fusion anomalies (pancreas divisum) were detected.
CONCLUSIONS
At the time of the first-round screening program in Italy, the rate of diagnosed lesions is lower than expected, all of them being BD-IPMNs. This might be due either to the low rate of syndromic HRI and to a low mean age compared to other series. The program is ongoing and 100 subjects are expected to receive the first round of screening by the end of 2017.
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