Neoplastic progression to pancreatic cancer slips by imaging surveillance

Imaging-based surveillance techniques may miss hallmarks of progression in high-risk individuals presenting with high-grade dysplasia or pancreatic cancer, suggesting a need for more sensitive tools, a recent study has found.

“In high-risk individuals, almost half of the neoplastic lesions were detected a median of 11 months after an unremarkable examination,” the researchers said. “The window of opportunity was shown to be narrow, emphasizing the need for more sensitive diagnostic tools and a better management strategy for rapidly growing cystic lesions in high-risk individuals.”

Researchers conducted a retrospective assessment of 122 high-risk individuals under surveillance, of whom 28 saw neoplastic progression to malignancy or high-grade dysplasia, diagnosed after a median of 29 months.

Among those whose disease progressed, imaging detected completely new lesions in 46 percent (n=13) a median of 11 months after the previous visit. In particular, seven (25 percent) of these patients showed no abnormalities at all during the previous visit. The remaining six patients, in comparison, had prevalent cystic lesions. However, the location of malignancies suggested that it most likely arose separate from the detected prevalent cysts.

Lesions had previously been detected in the remaining 15 of 28 progressors, 73 percent of whom (n=11) already showed evidence of progression beyond the pancreas.

Notably, compared with non-progressors, patients who saw incident neoplastic progression had significantly larger lesions at the last imaging test before diagnosis (median, 21 vs 8 mm; p=0.003). Absolute growth in lesions size also tended to be greater in progressors, though the effect fell short of significance.