Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1060, New York, NY, 10029, USA.
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
Pancreatology. 2020 Dec;20(8):1739-1746. doi: 10.1016/j.pan.2020.10.025. Epub 2020 Oct 9.
BACKGROUND/OBJECTIVES: Consensus guidelines recommend surveillance of high-risk individuals (HRIs) for pancreatic cancer (PC) using endoscopic ultrasonography (EUS) and/or magnetic resonance imaging (MRI). This study aims to assess the yield of PC surveillance programs of HRIs and compare the detection of high-grade dysplasia or T1N0M0 adenocarcinoma by EUS and MRI.
The MEDLINE and Embase (Ovid) databases were searched for prospective studies published up to April 11, 2019 using EUS and/or MRI to screen HRIs for PC. Baseline detection of focal pancreatic abnormalities, cystic lesions, solid lesions, high-grade dysplasia or T1N0M0 adenocarcinoma, and all pancreatic adenocarcinoma were recorded. Weighted pooled proportions of outcomes detected were compared between EUS and MRI using random effects modeling.
A total of 1097 studies were reviewed and 24 were included, representing 2112 HRIs who underwent imaging. The weighted pooled proportion of focal pancreatic abnormalities detected by baseline EUS (0.34, 95% CI 0.30-0.37) was significantly higher (p = 0.006) than by MRI (0.31, 95% CI 0.28-0.33). There were no significant differences between EUS and MRI in detection of other outcomes. The overall weighted pooled proportion of patients with high-grade dysplasia or T1N0M0 adenocarcinoma detected at baseline (regardless of imaging modality) was 0.0090 (95% CI 0.0022-0.016), corresponding to a number-needed-to-screen (NNS) of 111 patients to detect one high-grade dysplasia or T1N0M0 adenocarcinoma.
Surveillance programs are successful in detecting high-risk precursor lesions. No differences between EUS and MRI were noted in the detection of high-grade dysplasia or T1N0M0 adenocarcinoma, supporting the use of either imaging modality.
背景/目的：共识指南建议使用内镜超声检查（EUS）和/或磁共振成像（MRI）对胰腺癌（PC）高危个体（HRIs）进行监测。本研究旨在评估 HRIs 的 PC 监测计划的效果，并比较 EUS 和 MRI 对高级别异型增生或 T1N0M0 腺癌的检测。
使用 EUS 和/或 MRI 对高危个体进行 PC 筛查的前瞻性研究，检索截止日期为 2019 年 4 月 11 日的 MEDLINE 和 Embase（Ovid）数据库。记录基线时发现的局灶性胰腺异常、囊性病变、实性病变、高级别异型增生或 T1N0M0 腺癌以及所有胰腺腺癌的检出情况。采用随机效应模型比较 EUS 和 MRI 检测结果的加权汇总比例。
共回顾了 1097 项研究，其中 24 项研究符合纳入标准，共纳入 2112 例接受影像学检查的 HRIs。基线 EUS 检测局灶性胰腺异常的加权汇总比例（0.34，95%CI 0.30-0.37）显著高于 MRI（0.31，95%CI 0.28-0.33）（p=0.006）。EUS 和 MRI 检测其他结果无显著差异。基线时（无论影像学方式如何）检测到高级别异型增生或 T1N0M0 腺癌的患者总体加权汇总比例为 0.0090（95%CI 0.0022-0.016），对应于 111 例患者筛查 1 例高级别异型增生或 T1N0M0 腺癌的筛查所需患者数（NNS）。
监测计划成功检测到高危前体病变。EUS 和 MRI 在高级别异型增生或 T1N0M0 腺癌的检测中无差异，支持使用这两种影像学方法。
