The Clinical Significance of Extrapancreatic Incidental Findings Detected During Pancreas Surveillance

Cancer screening tests have the potential to detect cancers and precancerous conditions, but one concern is the potential that screen-detected incidental findings lead to unnecessary, potentially harmful interventions. The aim of this study is to determine, the yield of extrapancreatic incidental findings that required management, including cancers, precancerous lesions, and other findings of diagnostic concern in patients undergoing pancreatic surveillance for their familial or genetic pancreatic cancer risk.

We reviewed the pancreatic surveillance records of 925 patients enrolled in the Cancer of Pancreas Screening studies at The Johns Hopkins Hospital from 1998 to 2023 who had undergone at least one pancreatic surveillance test. Significant extra-pancreatic incidental findings that required diagnostic evaluation and/or treatment were tabulated, including the resulting diagnostic tests, therapeutic interventions, and complications.

The mean age/standard deviation at enrollment, of patients in the cohort was 58.0/10.4 years; 59.7% female), 220 (23.8%) had undergone baseline surveillance, 705 (76.2%) had undergone surveillance for a median of 4 years. Seventy-five extrapancreatic incidental findings were detected in 68 patients (7.3%), including 10 cancers, 80% of which were stage I and 8 (0.86%) precancerous lesions. Thirteen patients underwent surgical (n = 13), endoscopic (n = 9), or chemotherapy (n = 4). Twenty-five patients (2.7%) were recommended to undergo surveillance, (20 for nondysplastic Barrett's esophagus). Three patients (0.33%) were considered overtreated in retrospect (2 cholecystectomies, 1 partial nephrectomy, all laparoscopic). One patient had a postoperative complication treated successfully.

Extrapancreatic incidental findings are commonly detected in patients undergoing pancreatic surveillance, but few signify serious pathology. Almost all interventions for incidental findings were for cancerous and precancerous lesions, with few instances of unnecessary interventions.