Table 2

Statements that reached consensus

StatementAgreement gradegrade
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…
  •  45 years or 10 years younger than the youngest relative with PDAC

  •  50 years or 10 years younger than the youngest relative with PDAC

  •  55 years or 10 years younger than the youngest relative with PDAC

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…
  •  30 years or 10 years younger than the youngest relative with PDAC

  •  35 years or 10 years younger than the youngest relative with PDAC

  •  40 years or 10 years younger than the youngest relative with PDAC

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)
  •  EUS

  •  MRI/MRCP

  •  CT

  •  Abdominal ultrasound

86.8%
92.1%
19.7%
2.6%
2
2
4
5
 6. Follow-up pancreatic screening tests should include (multiple answers allowed)
  •  EUS

  •  MRI/MRCP

  •  CT

  •  Abdominal ultrasound

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 interval76.8%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 performed95.7%1
 17. At detection of a solid lesion, EUS-FNA should be performed…
  •  Always

  •  If ≥5 mm

  •  If ≥10 mm

  •  Never

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…
  •  EUS-FNA should be performed

  •  Surgery should be performed

75.7%
81.2%
1
2
 21. When an asymptomatic MPD stricture of unknown aetiology (without a mass) is
 detected…
  •  CT should be performed

  •  EUS-FNA should be performed

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…
  •  Regardless of size

  •  When ≥5 mm

  •  When ≥10 mm

64.7%
77.9%
91.2%
4
1
1
 24. In an HRI undergoing pancreatic screening, an IPMN should be resected in case of…
  •  A mural nodule

  •  An enhanced solid component

  •  Symptoms, including pancreatitis, jaundice, pain

  •  Thickened/enhanced cyst walls

  •  Abrupt change in MPD with distal pancreatic atrophy

  •  An MPD ≥10 mm

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 centres95.9%1
26. In cases of suspected PC, an oncological radical resection is indicated92.9%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:
  •  Resected cancer, confined to the pancreas, with negative margins, at baseline

  •  Resected cancer, confined to the pancreas, with negative margins, at follow-up

  •  Multifocal PanIN-3

  •  Unifocal PanIN-3

  •  IPMN with high-grade dysplasia

  •  Pancreatic neuroendocrine tumour ≥10 mm

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.