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Development of a high risk pancreatic screening clinic using 3.0A T MRI. Fam Cancer 2018 01;17(1):101-111

Date

11/05/2017

Pubmed ID

29101607

DOI

10.1007/s10689-017-0057-z

Scopus ID

2-s2.0-85032808589   14 Citations

Abstract

Selective screening for pancreatic cancer (PC) has been proposed. We describe the establishment of a comprehensive multidisciplinary screening program using 3.0A T MRI. Criteria for screening included the presence of PC in: a?Y 2 first degree relatives (FDR), 1 FDR and 1A s degree relative (SDR), a?Y 3 any degree relatives (ADR), or any known hereditary cancer syndrome with increased PC risk. Imaging with 3.0A T MRI was performed routinely and endoscopic ultrasound was used selectively. Screening was completed in 75 patients (pts). Hereditary cancer syndromes were present in 42 (56%) of the 75 pts: BRCA2 (18), ATM (8), BRCA1 (6), CDKN2A (4), PALB2 (3), Lynch (2), and Peutz-Jeghers (1). A family history of PC was present in a?Ya??2 FDR in 12 (16%) pts, 1 FDR and 1 SDR in 5 (7) pts, and a?Ya??3 ADR in 16 (21%) pts. Of the 65 pts who received screening MRI, 28 (43%) pts had pancreatic cystic lesions identified, including 1 (1%) patient in whom a cholangiocarcinoma was diagnosed as well. No patient underwent surgical resection. Using a 3.0A T MRI to screen patients at high risk for developing PC identified radiographic abnormalities in 43% of patients, which were stable on subsequent surveillance. Specific guidelines for the frequency of surveillance and indications for surgery remain areas of active investigation as the global experience with high risk screening continues to mature.

Author List

Barnes CA, Krzywda E, Lahiff S, McDowell D, Christians KK, Knechtges P, Tolat P, Hohenwalter M, Dua K, Khan AH, Evans DB, Geurts J, Tsai S

Authors

Kathleen K. Christians MD Professor in the Surgery department at Medical College of Wisconsin
Kulwinder S. Dua MD Professor in the Medicine department at Medical College of Wisconsin
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Jennifer L. Geurts MS, CGC Director, Assistant Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Mark D. Hohenwalter MD Vice Chair, Professor in the Radiology department at Medical College of Wisconsin
Parag P. Tolat MD Chief, Associate Professor in the Radiology department at Medical College of Wisconsin
Susan Tsai MD Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Early Detection of Cancer
Endosonography
Feasibility Studies
Female
Genetic Counseling
Genetic Predisposition to Disease
Genetic Testing
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neoplastic Syndromes, Hereditary
Pancreas
Pancreatic Neoplasms
Patient Care Team
Practice Guidelines as Topic
Risk Assessment