Mild dilation of the main pancreatic duct without an apparent obstructing mass may be an independent risk factor for neoplastic progression to pancreatic cancer in high-risk individuals, according to findings from an analysis published in Gastro Hep Advances.
“We are identifying pancreas duct dilatation as an early sign of pancreatic cancer in high-risk individuals even when there is no visible mass. This finding may lead to better survival if cancers are detected early,” stated corresponding author Marcia Irene Canto, MD, MHS, Professor of Medicine and Oncology at the Johns Hopkins University School of Medicine.
Background and Study Methods
Mild dilation of the main pancreatic duct is already considered to be a possible early indicator for an obstructing mass, but the effect of the dilation in high-risk individuals is not well understood.
Investigators assessed the prevalence and incidence of dilation of the main pancreatic duct to determine its relationship with neoplastic progression to high-grade dysplasia or pancreatic ductal adenocarcinoma in high-risk individuals. This analysis was part of the Cancer of Pancreas Screening (CAPS) study.
Data were collected from high-risk patients enrolled in the CAPS cohort studies. Risk for neoplastic progression was defined as ≥ 4 mm, ≥ 3 mm, and ≥ 2 mm diameter in the head, body, and tail, respectively, and time to progression was estimated based on baseline endoscopic ultrasounds and baseline duct dilation measurements.
Key Findings
A total of 641 high-risk individuals were followed for a median of 3.6 years (interquartile range = 1.9–7.2 years). Only 15% (n = 97) had dilation of the main pancreatic duct without evidence of an obstructing mass; 10 of these patients were diagnosed with neoplastic progression within a median of 2 years after the first detection of dilation.
Cumulative risk for high-grade dysplasia or pancreatic ductal adenocarcinoma in high-risk individuals following main pancreatic duct dilation was 16% at 5 years and 26% at 10 years. Any main pancreatic duct dilation in high-risk individuals led to a 2.6 times greater risk of progression (P = .05), especially for those with at least three pancreatic cysts (adjusted hazard ratio = 9.07; P < .001).
“By identifying this risk factor early, we were able to intervene more quickly,” said Dr. Canto. “The intervention would be to either operate or do much more frequent imaging. It was remarkable how even with the best imaging technology, a pancreatic cancer mass may not be visible even when it is causing structural changes in the gland. We have an opportunity to do better.”
“The dilatation is a red flag [in high-risk patients],” Dr. Canto added. “Providers should be aware that it is something that needs to be addressed right away.”
Going forward, the investigators are looking to employ artificial intelligence approaches to analyze imaging and clinical information to make more accurate risk predictions.
Disclosure: This work was supported by National Institutes of Health grants. Other funding sources are Susan Wojcicki and Dennis Troper and a Stand Up to Cancer-Lustgarten Foundation Pancreatic Cancer Interception Translational Cancer Research Grant administered by the American Association for Cancer Research. The work was also supported by the Pancreatic Cancer Action Network, the Rolfe Pancreatic Cancer Foundation, the V Foundation, the Hooven Memorial Fund, the Victor Family Pancreatic Cancer Fund, and the Pancreatic Cancer Hope Foundation. Dr. Canto reported receiving research grants from Pentax Medical Corporation and Merit Medical Corporation. Additionally, she is a consultant for Castle Biosciences and Clear Note Health, and she receives royalties from UpToDate. For full disclosures of the other study authors, visit ghadvances.org.
