Department of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.
Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
Pancreatology. 2022 Nov;22(7):951-958. doi: 10.1016/j.pan.2022.07.015. Epub 2022 Aug 8.
BACKGROUND/OBJECTIVES: Surveillance with endoscopic ultrasonography (EUS) and MRI/magnetic retrograde cholangiopancreatography (MRCP) is recommended for individuals at high risk for pancreatic cancer. We sought to characterize the findings of these surveillance exams and define the level of concordance between these two modalities.
173 asymptomatic high-risk individuals (HRIs) meeting criteria for pancreatic cancer surveillance underwent EUS, MRI/MRCP, or both between 2008 and 2021. Clinical records were reviewed in all cases.
HRIs underwent an average of 3.6 ± 3.2 surveillance exams over a period of 3.3 ± 3.5 years. Abnormalities including intraductal papillary mucinous neoplasms (IPMNs), solid lesions, and parenchymal irregularities were identified in 50.9% (n = 88). Four of these abnormalities (2.3%) had worrisome features, defined by cyst size, thickened/enhancing cyst walls, rapid growth rate, or change in main pancreatic duct diameter. All four worrisome lesions were seen on both MRI/MRCP and EUS. No pancreatic cancers were detected. Baseline EUS and MRI/MRCP exams were compared in 106 patients for concordance, and most (n = 66, 62.3%) were concordant. High levels of concordance were specifically observed for a dilated main pancreatic duct (p < 0.01) and cystic lesions >5 mm (p = 0.01). Among discordant cases, most (30/40; 75%) involved abnormal tissue heterogeneity seen primarily on EUS. None of these discordant lesions ultimately developed worrisome features.
Worrisome pancreatic lesions were uncommon in our high-risk pancreatic cancer population and were detected by both EUS and MRI/MRCP. There was mild discordance with respect to less worrisome findings, but these discrepancies were not associated with any adverse clinical outcomes.
背景/目的：对于胰腺癌高危人群，建议进行内镜超声检查（EUS）和 MRI/磁共振胰胆管成像（MRCP）监测。我们旨在描述这些监测检查的结果，并确定这两种方法的一致性程度。
2008 年至 2021 年间，共有 173 名符合胰腺癌监测标准的无症状高危个体（HRIs）接受了 EUS、MRI/MRCP 或两者的检查。所有病例均对临床记录进行了回顾。
HRIs 在 3.3 至 3.5 年的时间内平均接受了 3.6±3.2 次监测检查。在 50.9%（n=88）的患者中发现了异常，包括导管内乳头状黏液性肿瘤（IPMNs）、实体病变和实质不规则。其中 4 种异常（2.3%）具有令人担忧的特征，由囊肿大小、增厚/增强的囊壁、快速生长速度或主胰管直径变化定义。所有 4 个有担忧特征的病变均在 MRI/MRCP 和 EUS 上均可见。未发现胰腺癌。在 106 名患者中比较了基线 EUS 和 MRI/MRCP 检查的一致性，大多数（n=66，62.3%）是一致的。对于扩张的主胰管（p<0.01）和大于 5mm 的囊性病变（p=0.01），观察到高度一致性。在不一致的病例中，大多数（30/40；75%）涉及主要在 EUS 上观察到的异常组织异质性。这些不一致的病变最终均未出现令人担忧的特征。
在我们的高危胰腺癌人群中，令人担忧的胰腺病变并不常见，EUS 和 MRI/MRCP 均可检测到这些病变。对于不太令人担忧的发现，存在轻微的不一致，但这些差异与任何不良临床结局无关。
