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World J Gastroenterol. Sep 14, 2019; 25(34): 5082-5096
Published online Sep 14, 2019. doi: 10.3748/wjg.v25.i34.5082
Role of endoscopic ultrasound in the screening and follow-up of high-risk individuals for familial pancreatic cancer
Diane Lorenzo, Vinciane Rebours, Frédérique Maire, Maxime Palazzo, Jean-Michel Gonzalez, Marie-Pierre Vullierme, Alain Aubert, Pascal Hammel, Philippe Lévy, Louis de Mestier
Diane Lorenzo, Vinciane Rebours, Frédérique Maire, Maxime Palazzo, Alain Aubert, Philippe Lévy, Louis de Mestier, Pancreatology Department, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, and Paris Diderot University, Paris 75013, France
Vinciane Rebours, Louis de Mestier, INSERM, UMR1149, Paris 92110, France
Jean-Michel Gonzalez, Departement of Gastroenterology, Aix Marseille university - APHM - Hôpital Nord, Marseille 13000, France
Marie-Pierre Vullierme, Radiology Department, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, and Paris Diderot University, Paris 92110, France
Pascal Hammel, Oncology Department, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, and Paris Diderot University, Paris 92110, France
Author contributions: Lorenzo D, Rebours V, Lévy P and de Mestier L designed research; Lorenzo D, Rebours V, Maire F, Palazzo M, Gonzalez JM, Vullierme MP, Aubert A, Hammel P, Lévy P and de Mestier L performed research; Lorenzo D, Rebours V, Lévy P and de Mestier L contributed analytic tools; Lorenzo D, Rebours V, Maire F, Palazzo M, Gonzalez JM, Vullierme MP, Aubert A, Hammel P, Lévy P and de Mestier L analyzed data; Lorenzo D, Rebours V, Maire F, Palazzo M, Gonzalez JM, Vullierme MP, Aubert A, Hammel P, Lévy P and de Mestier L wrote the paper.
Conflict-of-interest statement: All the authors declare no potential conflict of interest in relation with this work.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Diane Lorenzo, MD, Doctor, Pôle des Maladies de l’Appareil Digestif, Service de Pancréatologie-Gastroentérologie, Hôpital BEAUJON, 100 boulevard du Général Leclerc, Clichy, France. diane.lorenzo@aphp.fr
Telephone: +33-1-40875215 Fax: +33-1-42703784
Received: June 5, 2019
Peer-review started: June 5, 2019
First decision: July 21, 2019
Revised: August 4, 2019
Accepted: August 24, 2019
Article in press: August 24, 2019
Published online: September 14, 2019
Processing time: 99 Days and 19.3 Hours
Abstract

Managing familial pancreatic cancer (FPC) is challenging for gastroenterologists, surgeons and oncologists. High-risk individuals (HRI) for pancreatic cancer (PC) (FPC or with germline mutations) are a heterogeneous group of subjects with a theoretical lifetime cumulative risk of PC over 5%. Screening is mainly based on annual magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS). The goal of screening is to identify early-stage operable cancers or high-risk precancerous lesions (pancreatic intraepithelial neoplasia or intraductal papillary mucinous neoplasms with high-grade dysplasia). In the literature, target lesions are identified in 2%-5% of HRI who undergo screening. EUS appears to provide better identification of small solid lesions (0%-46% of HRI) and chronic-pancreatitis-like parenchymal changes (14%-77% of HRI), while MRI is probably the best modality to identify small cystic lesions (13%-49% of HRI). There are no specific studies in HRI on the use of contrast-enhanced harmonic EUS. EUS can also be used to obtain tissue samples. Nevertheless, there is still limited evidence on the accuracy of imaging procedures used for screening or agreement on which patients to treat. The cost-effectiveness of screening is also unclear. Certain new EUS-related techniques, such as searching for DNA abnormalities or protein markers in pancreatic fluid, appear to be promising.

Keywords: Endoscopic ultrasound; Familial pancreatic cancer; Fine-needle aspiration; Intraductal papillary mucinous neoplasm; Pancreatic cancer; Pancreatic intraepithelial neoplasia; Pancreatic cancer screening guidelines

Core tip: High-risk individuals (HRI) for pancreatic cancer have a lifetime cumulative risk of this disorder of over 5%. The goal of screening is to identify operable cancers or precancerous lesions. Endoscopic ultrasound (EUS) appears to better identify solid lesions (0%-46% of HRI) and chronic-pancreatitis-like parenchymal changes (14%-77%), and magnetic resonance imaging to better identify small cysts (13%-49%). EUS is used to obtain tissue samples. There are no specific studies on contrast-enhanced harmonic EUS in HRI. There is limited evidence on the accuracy of imaging used for screening or agreement on which patients to treat. The cost-effectiveness of screening is also unclear. New EUS-related techniques (identifying DNA abnormalities or protein markers) appear to be promising.