Patients presenting with advanced-stage pancreatic cancer reveal cracks in imaging-based surveillance

High-risk individuals who develop neoplastic progression to pancreatic cancer (PC) or high-grade dysplasia can present at an advanced stage despite showing no lesions during prior imaging surveillance evaluations, a new study has found.

“In the framework of an imaging-based PC surveillance research program in high-risk individuals, almost half of the cases developed a neoplastic lesion without prior signs on imaging, and by the time of detection and/or surgical treatment, the majority had already progressed beyond an early stage,” the researchers said.

The retrospective analysis included 2,552 high-risk individuals under surveillance, 1 percent (n=28) of whom saw neoplastic progression to high-grade dysplasia or PC over a median follow-up of 29 months. Notably, 46 percent (n=13) of these progressors saw new lesions that developed since the previous surveillance examination, 77 percent (n=10) of which had progressed beyond the pancreas.

The remaining 54 percent (n=15) had neoplastic progression in lesions that had already been detected in prior examinations. Eleven (73 percent) of these patients had PC that had progressed beyond the pancreas.

Multivariable analysis found that compared with nonprogressors, risk factors for advanced neoplasia included advanced age, being female, a lesion size of ≥15 mm at the last imaging test, and having lesions located at the head or uncinate process of the pancreas.

“Progression to advanced PC therefore can occur before the next annual surveillance examination, posing the question if in certain high-risk individuals, shorter surveillance intervals are required,” the researchers said.