TOP LINE
More than half of carriers of pathogenic germline variants (PGV) BRCA1, BRCA2, ATMOr PALB2 undergoing pancreatic cancer surveillance had at least one imaging finding. However, most were mild or low risk and remained stable during short-term follow-up.
METHODOLOGY
- Surveillance for pancreatic cancer is recommended for certain people at high risk, including those with certain PGVs. But there is little information to share with patients on the frequency and long-term consequences of abnormalities detected by imaging.
- Researchers analyzed data prospectively collected from the PRECEDE consortium, a multicenter observational cohort of high-risk individuals undergoing pancreatic cancer surveillance imaging, including enrollees at 45 international institutions.
- A total of 2,085 participants with heterozygous PGV in BRCA1 (n = 432), BRCA2 (n = 1055), ATM (n = 403), or PALB2 (n = 195) and at least one surveillance imaging study were included. The median age at the time of initial imaging was 60 years; imaging was primarily endoscopic ultrasound and/or MRI/magnetic resonance cholangiopancreatography.
- Total surveillance follow-up was 2,166 person-years, with a median of two imaging studies per participant and a median interval of one year between studies.
TAKE AWAY
- Overall, 54% (1118/2085) of participants had pancreatic imaging findings; cysts were found in 35%, solid masses in 3.5%, and abnormalities of the main pancreatic duct in 5%. However, only 9% had a concerning finding, such as cysts with concerning features or dilation of the main pancreatic duct ≥5 mm.
- Twelve incident PCs (0.6%) were diagnosed, for an incidence of 5.54 per 1,000 person-years; 11 of 12 were stage I or II. Four pancreatic neuroendocrine tumors and two prevalent advanced pancreatic cancers were also identified.
- Of the 273 participants with cysts followed using the same modality, 13% (36) presented worrying growth (≥2.5 mm/year). Among participants without cysts or masses detected at baseline, 71% (304/428) remained free of new findings after at least two follow-up imaging studies.
- In multivariate analysis, older age was predictive of cysts (odds ratio (OR): 1.66; P. < 0.001), main anomalies of the pancreatic duct (OR: 1.37; P. = 0.004) and parenchymal changes. Additionally, the onset of diabetes was a predictor of cysts (OR: 2.48; P. = 0.010), as does family history of pancreatic cancer (OR: 1.51; P. < 0.001). And a history of pancreatitis predicted main pancreatic duct abnormalities (OR: 4.33; P. = .002).
IN PRACTICE
“These data provide a basis for counseling (to high-risk individuals) about the expected frequency and course of pancreatic imaging findings,” the study authors wrote. Although surveillance findings are common, they added, “what is important is that these findings are mostly benign and stable during the short-term follow-up period.”
SOURCE
The study, led by Samantha Kasselman, MS, CGC, of the University of Pennsylvania in Philadelphia, was published online in JCO Precision Oncology.
BOUNDARIES
The cohort was predominantly female (72%) and white (89%) and may not represent the broader population of high-risk individuals. Imaging results may be affected by inter-reader variability and detection bias, and few participants underwent EUS and MRI simultaneously, limiting comparison of modalities. Follow-up was short and the solid mass sample was small.
DISCLOSURES
The study was supported by the Basser Center for BRCA and several family research funds. Several co-authors reported consulting, speaking, or research ties with industry. Full information is available in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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