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Original article
A multicentre comparative prospective blinded analysis of EUS and MRI for screening of pancreatic cancer in high-risk individuals
  1. F Harinck1,
  2. I C A W Konings1,
  3. I Kluijt2,
  4. J W Poley1,
  5. J E van Hooft3,
  6. H M van Dullemen4,
  7. C Y Nio5,
  8. N C Krak6,
  9. J J Hermans7,
  10. C M Aalfs8,
  11. A Wagner9,
  12. R H Sijmons10,
  13. K Biermann11,
  14. C H van Eijck12,
  15. D J Gouma13,
  16. M G W Dijkgraaf14,
  17. P Fockens3,
  18. M J Bruno1
  19. on behalf of the Dutch research group on pancreatic cancer surveillance in high-risk individuals
  1. 1Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2Family Cancer Clinic, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
  3. 3Department of Gastroenterology and Hepatology, Amsterdam Medical Center, University Medical Center Amsterdam, Amsterdam, The Netherlands
  4. 4Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  5. 5Department of Radiology, Amsterdam Medical Center, University Medical Center Amsterdam, Amsterdam, The Netherlands
  6. 6Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  7. 7Department of Radiology and Nuclear Medicine, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
  8. 8Department of Clinical Genetics, Amsterdam Medical Center, University Medical Center Amsterdam, Amsterdam, The Netherlands
  9. 9Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  10. 10Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  11. 11Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  12. 12Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  13. 13Department of Surgery, Amsterdam Medical Center, University Medical Center Amsterdam, Amsterdam, The Netherlands
  14. 14Clinical Research Unit, Amsterdam Medical Center, University Medical Center Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to F Harinck, Erasmus MC, University Medical Center Rotterdam, s Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands; f.harinck{at}erasmusmc.nl

Abstract

Objective Endoscopic ultrasonography (EUS) and MRI are promising tests to detect precursors and early-stage pancreatic ductal adenocarcinoma (PDAC) in high-risk individuals (HRIs). It is unclear which screening technique is to be preferred. We aimed to compare the efficacy of EUS and MRI in their ability to detect clinically relevant lesions in HRI.

Design Multicentre prospective study. The results of 139 asymptomatic HRI (>10-fold increased risk) undergoing first-time screening by EUS and MRI are described. Clinically relevant lesions were defined as solid lesions, main duct intraductal papillary mucinous neoplasms and cysts ≥10 mm. Results were compared in a blinded, independent fashion.

Results Two solid lesions (mean size 9 mm) and nine cysts ≥10 mm (mean size 17 mm) were detected in nine HRI (6%). Both solid lesions were detected by EUS only and proved to be a stage I PDAC and a multifocal pancreatic intraepithelial neoplasia 2. Of the nine cysts ≥10 mm, six were detected by both imaging techniques and three were detected by MRI only. The agreement between EUS and MRI for the detection of clinically relevant lesions was 55%. Of these clinically relevant lesions detected by both techniques, there was a good agreement for location and size.

Conclusions EUS and/or MRI detected clinically relevant pancreatic lesions in 6% of HRI. Both imaging techniques were complementary rather than interchangeable: contrary to EUS, MRI was found to be very sensitive for the detection of cystic lesions of any size; MRI, however, might have some important limitations with regard to the timely detection of solid lesions.

  • PANCREATIC CANCER
  • ENDOSCOPIC ULTRASONOGRAPHY
  • MAGNETIC RESONANCE IMAGING
  • SCREENING
  • SURVEILLANCE

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