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Mild Dilatation of the Main Pancreatic Duct Is a Risk Factor for Progression to Pancreatic Cancer in High-Risk
Elizabeth Abou Diwan1, Helena Saba1, Amanda L Blackford2
1Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins School of Medicine, Baltimore, Maryland.
Background And Aims:
Mild dilatation of the main pancreatic duct (MPD) can be an early indicator of an obstructing mass, but its clinical significance in asymptomatic high-risk individuals (HRIs) undergoing surveillance has not been defined. We determined the prevalence and incidence of MPD dilation in HRI and assessed its association with neoplastic progression (to high-grade dysplasia or pancreatic ductal adenocarcinoma (PDAC)) in HRI.
Methods:
We analyzed prospectively collected data from HRIs enrolled in the Cancer of Pancreas Screening cohort studies. We determined the risk of neoplastic progression associated with MPD dilation (defined as ≥4, ≥3, ≥2 mm diameter, in the head, body, tail, respectively) using Cox regression and time-varying covariate analysis. We estimated time-to-progression from baseline endoscopic ultrasound and from baseline duct dilation by the Kaplan-Meier method.
Results:
Of 641 HRIs followed for a median 3.6 years (interquartile range 1.9-7.2), 97 (15%) had MPD dilation without evidence of an obstructing mass lesion; 10 of whom (10.3%) were diagnosed with neoplastic progression within a median of 2 years after dilation was first detected. The cumulative probability of high-grade dysplasia/PDAC in HRI with baseline MPD dilation was 16% at 5 years and 26% at 10 years. HRI with any MPD dilation were 2.6 times more likely to progress (P = .05), particularly those with ≥ 3 pancreatic cysts during surveillance (adjusted hazard ratio = 9.07, P < .001).
Conclusion:
MPD dilation without an apparent obstructing lesion is an independent risk factor for neoplastic progression in HRI.
Insights
Mild pancreatic duct dilation in high-risk individuals may indicate a higher risk of pancreatic cancer progression. This finding is crucial for surveillance strategies in asymptomatic individuals.
Area of Science:
- Gastroenterology
- Oncology
- Medical Surveillance
Background:
- Mild main pancreatic duct (MPD) dilation can signal an obstructing mass but its significance in asymptomatic high-risk individuals (HRIs) is unclear.
- Surveillance of HRIs aims to detect early signs of pancreatic neoplastic progression.
Purpose of the Study:
- To determine the prevalence and incidence of MPD dilation in HRIs.
- To assess the association between MPD dilation and neoplastic progression to high-grade dysplasia or pancreatic ductal adenocarcinoma (PDAC) in HRIs.
Main Methods:
- Prospective data analysis from HRIs in the Cancer of Pancreas Screening cohort.
- Cox regression and Kaplan-Meier methods were used to analyze the risk of neoplastic progression associated with MPD dilation.
Main Results:
- 15% of HRIs (97/641) exhibited MPD dilation without an obstructing mass.
- 10.3% of those with dilation progressed to high-grade dysplasia/PDAC within 2 years.
- MPD dilation increased the likelihood of progression 2.6-fold (P=0.05), with ≥3 pancreatic cysts significantly raising this risk (aHR=9.07, P<0.001).
Conclusions:
- MPD dilation, even without an apparent obstructing lesion, is an independent risk factor for neoplastic progression in HRIs.
- These findings support closer monitoring of HRIs with MPD dilation.
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