Statements that reached consensus
Statement | Agreement grade | grade |
At what age should pancreatic surveillance begin? | ||
1. For patients with a familial risk (no known germline mutations or PJS), screening should begin by the age of…
| 10.3% 67.6% 22.1% | 4 2 2 |
2. For germline mutation carriers (excluding PJS), screening should begin 5 years earlier than for high-risk individuals with defined familial pancreatic cancer | 74.7% | 2 |
3. For patients with PJS, screening should begin at least by the age of…
| 14.9% 17.9% 67.2% | 4 4 2 |
4. New-onset diabetes in a high-risk individual should lead to initiation of screening, regardless of age. | 82.4% | 2 |
How should high-risk individuals be screened? | ||
5. Baseline pancreatic screening tests should include (multiple answers allowed)
| 86.8% 92.1% 19.7% 2.6% | 2 2 4 5 |
6. Follow-up pancreatic screening tests should include (multiple answers allowed)
| 89.5% 89.5% 15.8% 1.3% | 2 2 4 5 |
7. CA19-9 should be used as an additional surveillance test for individuals with worrisome features on imaging | 76.5% | 2 |
8. Routine testing for diabetes mellitus with fasting blood glucose and/or haemoglobin A1c should be performed. | 76.1% | 2 |
Surveillance questions | ||
9. In the absence of pancreatic abnormalities, the recommended surveillance interval is 12 months | 90.4% | 2 |
10. For patients with small (<1 cm), non-functioning neuroendocrine tumours, the recommended surveillance interval is 12 months | 82.6% | 2 |
11. For patients with low-risk findings (ie, pancreatic lobulation or a cyst without worrisome features), the recommended surveillance interval is 12 months | 88.6% | 2 |
12. For CDKN2A p16 mutation carriers with newly detected pancreatic abnormalities that are concerning but do not lead to surgery (mild MPD dilation, stricture without mass), repeat imaging should be performed within 3–6 months | 98.5% | 2 |
13. A diagnosis of new-onset diabetes* in an HRI under surveillance, prompts immediate investigations | 90.3% | 2 |
14. Smoking status does not affect the surveillance interval | 76.8% | 2 |
15. When a cystic lesion with worrisome features (ie, mural nodule, solid component, duct dilation, etc) is detected, EUS-FNA should be performed. | 84.3% | 2 |
16.When a solid lesion is detected, CT should be performed | 95.7% | 1 |
17. At detection of a solid lesion, EUS-FNA should be performed…
| 70.1% 19.4% 4.5% 6.0% | 2 1 1 5 |
18. When a solid lesion of uncertain significance is newly detected and the patient is not referred for surgery, imaging should be repeated after 3 months | 91.2% | 1 |
19. Standardised nomenclature should be used to define chronic pancreatitis-like abnormalities | 98.6% | 2 |
20. When an asymptomatic MPD stricture with an associated suspicious mass is detected…
| 75.7% 81.2% | 1 2 |
21. When an asymptomatic MPD stricture of unknown aetiology (without a mass) is detected…
| 86.6% 77.9% | 1 1 |
22. When a patient with an MPD stricture is not referred for surgery, repeat imaging should be performed within 3 months | 98.5% | 1 |
When should surgery be performed? | ||
23. A solid lesion, detected by EUS (except biopsy-proven or highly suspicious to be neuroendocrine, autoimmune or other benign conditions) should be resected…
| 64.7% 77.9% 91.2% | 4 1 1 |
24. In an HRI undergoing pancreatic screening, an IPMN should be resected in case of…
| 91.0% 97.0% 95.5% 76.1% 91.0% 97.0% | 1 1 1 1 1 1 |
25. Pancreatic resections should be performed at specialty centres | 95.9% | 1 |
26. In cases of suspected PC, an oncological radical resection is indicated | 92.9% | 1 |
27. When an HRI undergoes surgery for suspected small PC (max. 1 cm, T1M0N0 on imaging), a partial pancreatectomy is suitable | 89.6% | 2 |
Goals of surveillance | ||
28. Detection and treatment of the following pathological lesion should be considered a 'success' of a screening programme:
| 96% 85% 99% 97% 97% 75% | 1 1 2 2 1 2 |
CA19-9, carbohydrate antigen 19–9; CDKN2A, cyclin-dependent kinase inhibitor 2A; CT, computed tomography; EUS, endoscopic ultrasound; FNA, fine-needle aspiration; HRI, high-risk individual; IPMN, intraductal papillary mucinous neoplasm; MPD, main pancreatic duct; MRI/MRCP, magnetic resonance imaging/magnetic retrograde cholangiopancreatography; PanIN-3, pancreatic intraepithelial neoplasia-3; PC, pancreatic ductal adenocarcinoma; PDAC, pancreatic ductal adenocarcinoma; PJS, Peutz-Jeghers syndrome.