Development of a high risk pancreatic screening clinic using 3.0 T MRI
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Selective screening for pancreatic cancer (PC) has been proposed. We describe the establishment of a comprehensive multidisciplinary screening program using 3.0 T MRI. Criteria for screening included the presence of PC in: ≥ 2 first degree relatives (FDR), 1 FDR and 1 s degree relative (SDR), ≥ 3 any degree relatives (ADR), or any known hereditary cancer syndrome with increased PC risk. Imaging with 3.0 T MRI was performed routinely and endoscopic ultrasound was used selectively. Screening was completed in 75 patients (pts). Hereditary cancer syndromes were present in 42 (56%) of the 75 pts: BRCA2 (18), ATM (8), BRCA1 (6), CDKN2A (4), PALB2 (3), Lynch (2), and Peutz-Jeghers (1). A family history of PC was present in ≥ 2 FDR in 12 (16%) pts, 1 FDR and 1 SDR in 5 (7) pts, and ≥ 3 ADR in 16 (21%) pts. Of the 65 pts who received screening MRI, 28 (43%) pts had pancreatic cystic lesions identified, including 1 (1%) patient in whom a cholangiocarcinoma was diagnosed as well. No patient underwent surgical resection. Using a 3.0 T MRI to screen patients at high risk for developing PC identified radiographic abnormalities in 43% of patients, which were stable on subsequent surveillance. Specific guidelines for the frequency of surveillance and indications for surgery remain areas of active investigation as the global experience with high risk screening continues to mature.
KeywordsFamilial pancreatic cancer High risk Pancreas cancer screening
The authors acknowledge the support of the We Care Fund for Medical Innovation and Research, the Ronald Burklund Eich Pancreatic Research Fund, and the Lockton Funds for Pancreatic Cancer Research from the Department of Surgery at the Medical College of Wisconsin. ST acknowledges support from the Institutional Research Grant # 86-004-26 from the American Cancer Society and the Department of Veterans Affairs. The authors would like to thank Wendy Behrs for assistance with manuscript preparation.
American Cancer Association Pilot Grant, WeCare Foundation, Ronald Burkland Eich Pancreatic Research Fund, Advancing Healthier Wisconsin.
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