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01-01-2018 | Original Article

Development of a high risk pancreatic screening clinic using 3.0 T MRI

Authors: Chad A. Barnes, Elizabeth Krzywda, Shannon Lahiff, Dena McDowell, Kathleen K. Christians, Paul Knechtges, Parag Tolat, Mark Hohenwalter, Kulwinder Dua, Abdul H. Khan, Douglas B. Evans, Jennifer Geurts, Susan Tsai

Published in: Familial Cancer | Issue 1/2018

Abstract

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.

Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA Cancer J Clin 66(1):7–30CrossRefPubMed

Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD, Yeo CJ (2006) 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg 10(9):1199–1210CrossRefPubMed

Yachida S, Jones S, Bozic I, Antal T, Leary R, Fu B, Kamiyama M, Hruban RH, Eshleman JR, Nowak MA, Velculescu VE, Kinzler KW, Vogelstein B, Iacobuzio-Donahue CA (2010) Distant metastasis occurs late during the genetic evolution of pancreatic cancer. Nature 467(7319):1114–1117CrossRefPubMedPubMedCentral

Corley DA, Jensen CD, Marks AR, Zhao WK, Lee JK, Doubeni CA, Zauber AG, de Boer J, Fireman BH, Schottinger JE, Quinn VP, Ghai NR, Levin TR, Quesenberry CP (2014) Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 370(14):1298–1306CrossRefPubMedPubMedCentral

Canto MI, Harinck F, Hruban RH, Offerhaus GJ, Poley JW, Kamel I, Nio Y, Schulick RS, Bassi C, Kluijt I, Levy MJ, Chak A, Fockens P, Goggins M, Bruno M, International Cancer of Pancreas Screening C (2013) International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer. Gut 62(3):339–347CrossRefPubMed

Canto MI, Goggins M, Yeo CJ, Griffin C, Axilbund JE, Brune K, Ali SZ, Jagannath S, Petersen GM, Fishman EK, Piantadosi S, Giardiello FM, Hruban RH (2004) Screening for pancreatic neoplasia in high-risk individuals: an EUS-based approach. Clin Gastroenterol Hepatol 2(7):606–621CrossRefPubMed

Langer P, Kann PH, Fendrich V, Habbe N, Schneider M, Sina M, Slater EP, Heverhagen JT, Gress TM, Rothmund M, Bartsch DK (2009) Five years of prospective screening of high-risk individuals from families with familial pancreatic cancer. Gut 58(10):1410–1418CrossRefPubMed

Brentnall TA, Bronner MP, Byrd DR, Haggitt RC, Kimmey MB (1999) Early diagnosis and treatment of pancreatic dysplasia in patients with a family history of pancreatic cancer. Ann Intern Med 131(4):247–255CrossRefPubMed

Canto MI, Hruban RH, Fishman EK, Kamel IR, Schulick R, Zhang Z, Topazian M, Takahashi N, Fletcher J, Petersen G, Klein AP, Axilbund J, Griffin C, Syngal S, Saltzman JR, Mortele KJ, Lee J, Tamm E, Vikram R, Bhosale P, Margolis D, Farrell J, Goggins M, American Cancer of the Pancreas Screening C (2012) Frequent detection of pancreatic lesions in asymptomatic high-risk individuals. Gastroenterology 142(4):796–804 quiz e714-795.CrossRefPubMedPubMedCentral

10.

Poley JW, Kluijt I, Gouma DJ, Harinck F, Wagner A, Aalfs C, van Eijck CH, Cats A, Kuipers EJ, Nio Y, Fockens P, Bruno MJ (2009) The yield of first-time endoscopic ultrasonography in screening individuals at a high risk of developing pancreatic cancer. Am J Gastroenterol 104(9):2175–2181CrossRefPubMed

11.

Ludwig E, Olson SH, Bayuga S, Simon J, Schattner MA, Gerdes H, Allen PJ, Jarnagin WR, Kurtz RC (2011) Feasibility and yield of screening in relatives from familial pancreatic cancer families. Am J Gastroenterol 106(5):946–954CrossRefPubMedPubMedCentral

12.

Al-Sukhni W, Borgida A, Rothenmund H, Holter S, Semotiuk K, Grant R, Wilson S, Moore M, Narod S, Jhaveri K, Haider MA, Gallinger S (2012) Screening for pancreatic cancer in a high-risk cohort: an eight-year experience. J Gastrointest Surg 16(4):771–783CrossRefPubMed

13.

Vasen HF, Wasser M, van Mil A, Tollenaar RA, Konstantinovski M, Gruis NA, Bergman W, Hes FJ, Hommes DW, Offerhaus GJ, Morreau H, Bonsing BA, de Vos tot Nederveen Cappel WH (2011) Magnetic resonance imaging surveillance detects early-stage pancreatic cancer in carriers of a p16-Leiden mutation. Gastroenterology 140(3):850–856CrossRefPubMed

14.

Vasen H, Ibrahim I, Ponce CG, Slater EP, Matthai E, Carrato A, Earl J, Robbers K, van Mil AM, Potjer T, Bonsing BA, de Vos tot Nederveen Cappel WH, Bergman W, Wasser M, Morreau H, Kloppel G, Schicker C, Steinkamp M, Figiel J, Esposito I, Mocci E, Vazquez-Sequeiros E, Sanjuanbenito A, Munoz-Beltran M, Montans J, Langer P, Fendrich V, Bartsch DK (2016) Benefit of surveillance for pancreatic cancer in high-risk individuals: outcome of long-term prospective follow-up studies from three European expert centers. J Clin Oncol 34(17):2010–2019CrossRefPubMed

15.

Brentnall TA (2011) Pancreatic cancer surveillance: learning as we go. Am J Gastroenterol 106(5):955–956CrossRefPubMed

16.

Syngal S, Brand RE, Church JM, Giardiello FM, Hampel HL, Burt RW, American College of G (2015) ACG clinical guideline: genetic testing and management of hereditary gastrointestinal cancer syndromes. Am J Gastroenterol 110(2):223–262 quiz 263.CrossRefPubMedPubMedCentral

17.

Richards CS, Bale S, Bellissimo DB, Das S, Grody WW, Hegde MR, Lyon E, Ward BE, Molecular Subcommittee of the ALQAC (2008) ACMG recommendations for standards for interpretation and reporting of sequence variations: Revisions 2007. Genet Med 10(4):294–300CrossRefPubMed

18.

Richards S, Aziz N, Bale S, Bick D, Das S, Gastier-Foster J, Grody WW, Hegde M, Lyon E, Spector E, Voelkerding K, Rehm HL, Committee ALQA (2015) Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. Genet Med 17(5):405–424CrossRefPubMedPubMedCentral

19.

American Society of Clinical O (2003) American Society of Clinical Oncology policy statement update: genetic testing for cancer susceptibility. J Clin Oncol 21(12):2397–2406CrossRef

20.

Hu C, Hart SN, Bamlet WR, Moore RM, Nandakumar K, Eckloff BW, Lee YK, Petersen GM, McWilliams RR, Couch FJ (2016) Prevalence of pathogenic mutations in cancer predisposition genes among pancreatic cancer patients. Cancer Epidemiol Biomark Prev 25(1):207–211CrossRef

21.

Wang W, Chen S, Brune KA, Hruban RH, Parmigiani G, Klein AP (2007) PancPRO: risk assessment for individuals with a family history of pancreatic cancer. J Clin Oncol 25(11):1417–1422CrossRefPubMedPubMedCentral

22.

Leonardi G, Marchi S, Falconi M, Zerbi A, Ussia V, de Bortoli N, Mosca F, Presciuttini S, Del Chiaro M (2012) “PancPro” as a tool for selecting families eligible for pancreatic cancer screening: an Italian study of incident cases. Dig Liver Dis 44(7):585–588CrossRefPubMed

23.

Bartsch DK, Gress TM, Langer P (2012) Familial pancreatic cancer–current knowledge. Nat Rev Gastroenterol Hepatol 9(8):445–453CrossRefPubMed

24.

Edelman RR, Salanitri G, Brand R, Dunkle E, Ragin A, Li W, Mehta U, Berlin J, Newmark G, Gore R, Patel B, Carillo A, Vu A (2006) Magnetic resonance imaging of the pancreas at 3.0 T: qualitative and quantitative comparison with 1.5 T. Invest Radiol 41(2):175–180CrossRefPubMed

25.

Spinelli KS, Fromwiller TE, Daniel RA, Kiely JM, Nakeeb A, Komorowski RA, Wilson SD, Pitt HA (2004) Cystic pancreatic neoplasms: observe or operate. Ann Surg 239(5):651–657 (discussion 657–659)CrossRefPubMedPubMedCentral

26.

Potjer TP, Schot I, Langer P, Heverhagen JT, Wasser MN, Slater EP, Kloppel G, Morreau HM, Bonsing BA, de Vos tot Nederveen Cappel WH, Bargello M, Gress TM, Vasen HF, Bartsch DK, Leiden Familial Pancreatic Cancer G, FaPaCa r (2013) Variation in precursor lesions of pancreatic cancer among high-risk groups. Clin Cancer Res 19(2):442–449CrossRefPubMed

27.

Brune K, Abe T, Canto M, O’Malley L, Klein AP, Maitra A, Volkan Adsay N, Fishman EK, Cameron JL, Yeo CJ, Kern SE, Goggins M, Hruban RH (2006) Multifocal neoplastic precursor lesions associated with lobular atrophy of the pancreas in patients having a strong family history of pancreatic cancer. Am J Surg Pathol 30(9):1067–1076PubMedPubMedCentral

28.

Shi C, Klein AP, Goggins M, Maitra A, Canto M, Ali S, Schulick R, Palmisano E, Hruban RH (2009) Increased prevalence of precursor lesions in familial pancreatic cancer patients. Clin Cancer Res 15(24):7737–7743CrossRefPubMedPubMedCentral

29.

Bartsch DK, Dietzel K, Bargello M, Matthaei E, Kloeppel G, Esposito I, Heverhagen JT, Gress TM, Slater EP, Langer P (2013) Multiple small “imaging” branch-duct type intraductal papillary mucinous neoplasms (IPMNs) in familial pancreatic cancer: indicator for concomitant high grade pancreatic intraepithelial neoplasia? Fam Cancer 12(1):89–96CrossRefPubMed

30.

Jones S, Zhang X, Parsons DW, Lin JC, Leary RJ, Angenendt P, Mankoo P, Carter H, Kamiyama H, Jimeno A, Hong SM, Fu B, Lin MT, Calhoun ES, Kamiyama M, Walter K, Nikolskaya T, Nikolsky Y, Hartigan J, Smith DR, Hidalgo M, Leach SD, Klein AP, Jaffee EM, Goggins M, Maitra A, Iacobuzio-Donahue C, Eshleman JR, Kern SE, Hruban RH, Karchin R, Papadopoulos N, Parmigiani G, Vogelstein B, Velculescu VE, Kinzler KW (2008) Core signaling pathways in human pancreatic cancers revealed by global genomic analyses. Science 321(5897):1801–1806CrossRefPubMedPubMedCentral

31.

Notta F, Chan-Seng-Yue M, Lemire M, Li Y, Wilson GW, Connor AA, Denroche RE, Liang SB, Brown AM, Kim JC, Wang T, Simpson JT, Beck T, Borgida A, Buchner N, Chadwick D, Hafezi-Bakhtiari S, Dick JE, Heisler L, Hollingsworth MA, Ibrahimov E, Jang GH, Johns J, Jorgensen LG, Law C, Ludkovski O, Lungu I, Ng K, Pasternack D, Petersen GM, Shlush LI, Timms L, Tsao MS, Wilson JM, Yung CK, Zogopoulos G, Bartlett JM, Alexandrov LB, Real FX, Cleary SP, Roehrl MH, McPherson JD, Stein LD, Hudson TJ, Campbell PJ, Gallinger S (2016) A renewed model of pancreatic cancer evolution based on genomic rearrangement patterns. Nature 538(7625):378–382CrossRefPubMedPubMedCentral

32.

Bartsch DK, Slater EP, Carrato A, Ibrahim IS, Guillen-Ponce C, Vasen HF, Matthai E, Earl J, Jendryschek FS, Figiel J, Steinkamp M, Ramaswamy A, Vazquez-Sequeiros E, Munoz-Beltran M, Montans J, Mocci E, Bonsing BA, Wasser M, Kloppel G, Langer P, Fendrich V, Gress TM (2016) Refinement of screening for familial pancreatic cancer. Gut 65(8):1314–1321CrossRefPubMed

33.

Tanaka M, Fernandez-del Castillo C, Adsay V, Chari S, Falconi M, Jang JY, Kimura W, Levy P, Pitman MB, Schmidt CM, Shimizu M, Wolfgang CL, Yamaguchi K, Yamao K, International Association of P (2012) International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 12(3):183–197CrossRefPubMed

Title: Development of a high risk pancreatic screening clinic using 3.0 T MRI
Authors: Chad A. Barnes
Elizabeth Krzywda
Shannon Lahiff
Dena McDowell
Kathleen K. Christians
Paul Knechtges
Parag Tolat
Mark Hohenwalter
Kulwinder Dua
Abdul H. Khan
Douglas B. Evans
Jennifer Geurts
Susan Tsai
Publication date: 01-01-2018
Publisher: Springer Netherlands
Published in: Familial Cancer / Issue 1/2018
Print ISSN: 1389-9600
Electronic ISSN: 1573-7292
DOI: https://doi.org/10.1007/s10689-017-0057-z

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