Table 2

Summary of consensus statements for the management of high risk individuals

Who should be screened?
Statements
A1Individuals with three or more affected blood relatives, with at least one affected FDR, should be considered for screening.
A2Individuals with at least two affected FDRs with PC, with at least one affected FDR, should be considered for screening once they reach a certain age.
A3Individuals with two or more affected blood relatives with PC, with at least one affected FDR, should be considered for screening.
A4All patients with Peutz–Jeghers syndrome should be screened, regardless of family history of PC.
A5p16 carriers with one affected FDR should be considered for screening.
A6BRCA2 mutation carriers with one affected FDR should be considered for screening.
A7BRCA2 mutation carriers with two affected family members (no FDR) with PC should be considered for screening.
A8PALB2 mutation carriers with one affected FDR should be considered for screening.
A9Mismatch repair gene mutation carriers (Lynch syndrome) with one affected FDR should be considered for screening.
How should high-risk individuals be screened?
Statements
B1Initial screening should include (multiple answers allowed):
EUS 83.7%, MRI/MRCP 73.5%, CT 26.5%, abdominal ultrasound 14.3%, ERCP 2.0%.
B2When previous screening did not detect an abnormality that met criteria for shortening of the interval or surgical resection, follow-up screening should include (multiple answers allowed): EUS 79.6% MRI/MRCP 69.4%, CT 22.4%, abdominal ultrasound 4.1%, ERCP 2.0%.
B3Standardised nomenclature should be used to define chronic pancreatitis-like abnormalities.
B4Whenever a cystic lesion is detected, an additional ERCP should not be performed.
B5Patients with a cystic lesion without worrisome features for malignancy should have an imaging test after 6–12 months.
B6When a solid lesion is detected, CT should also be performed.
B7When a solid lesion is detected, ERCP should not be performed.
B8When a solid lesion is detected at baseline with an indeterminate diagnosis and the patient is not referred for immediate surgery, imaging should be repeated after 3 months.
B9When a new solid lesion is detected at follow-up with an indeterminate diagnosis and the patient is not referred for immediate surgery, imaging should be repeated after 3 months.
B10 If an indeterminate main pancreatic duct stricture without a mass is detected, repeat imaging should be performed within 3 months.
When should surgery be performed?
Statements
C1Screening should only be offered to individuals who are candidates for surgery.
C2Pancreatic resections should be performed at specialty centres (taking into account volume, morbidity and mortality rates and expertise available).
C3Intraoperatively, further pancreatectomy (up to a possible total) should be performed in patients with otherwise reasonable life expectancy to achieve R0 resection of cancer.
C4Intraoperatively, further pancreatectomy (up to a possible total) should not be performed in a patient with otherwise reasonable life expectancy and no cancer but with unifocal PanIN-2 in the resected specimen but not at the margin.
C5Postoperatively, further pancreatectomy (up to a possible total) should be not performed in patients with otherwise reasonable life expectancy in a patient without cancer in the resected specimen but with PanIN-2 at margin.
C6Postoperatively, further pancreatectomy (up to possible total) should be not be performed in patients with otherwise reasonable life expectancy in a patient who did not have cancer but had unifocal PanIN-2 in the resected specimens but not at the margin.
C7Postoperatively, further pancreatectomy (up to a possible total) should be not performed in patients with otherwise reasonable life expectancy in a patient without cancer but who has multifocal PanIN-2 in the resected specimens but not at the margin.
What are the goals of screening? What outcome(s) would be considered a ‘success’?
Statements
D1Resectable carcinoma is a potential target for early detection and treatment.
D2PanINs are a potential target for early detection and treatment.
D3IPMNs are a potential target for early detection and treatment.
D4Detection and treatment of multifocal PanIN-3 should be considered a success of a screening/surveillance programme.
D5Detection and treatment of IPMNs with high-grade dysplasia should be considered a success of a screening/surveillance programme.
D6Detection and treatment of invasive cancer-T1N0M0 detected at baseline should be considered a success of a screening programme.
D7Treatment of invasive cancer-T1N0M0 detected at follow-up should be considered a success of a screening programme.
D8Detection and treatment of invasive cancer >T1N0M0 resectable with margins negative at baseline, should be considered a success of a screening programme.
  • ERCP, endoscopic retrograde cholangiopancreatography; EUS, endoscopic ultrasonography; FDR, first-degree relative; IPMN, intraductal papillary mucinous neoplasm; MRCP, magnetic resonance cholangiopancreatography; PC, pancreatic cancer; PanIN, pancreatic intraepithelial neoplasia.