Study paves way for earlier pancreatic cancer diagnoses in patients with low-risk pancreatic cysts

Catching pancreatic cancer early can increase the five-year survival rate from 15% to 80%. Patients with pancreatic cysts, frequently detected during unrelated abdominal CT or MRI imaging, can develop malignant pancreatic cancers. In a new study, Mass General Brigham investigators showed that patients with low-risk pancreatic cystic lesions (PCLs) have approximately 14 times higher risk of developing pancreatic cancer than the general population. They found that patients with larger low-risk cysts and older patients, particularly those over 70 years of age, were at greater risk for cancer. The results are published in JAMA Network Open.

"Our study underscores the need for long-term personalized surveillance strategies for patients with incidentally discovered low-risk pancreatic cysts," said senior author Ramin Khorasani MD, MPH, the director and co-founder of the Center for Evidence-Based Imaging, Radiology Quality Vice Chair and Assistant Chief Medical Officer at Mass General Brigham. "This approach could enable earlier detection of pancreatic cancer, when treatment is more likely to succeed."

Using abdominal imaging (MRI or CT scans) from 499,631 patients who were seen at Mass General Brigham between 2009 and 2021, the researchers identified 6,064 patients with low-risk PCLs. They followed these patients for an average of 3.3 years after the initial PCL detection to identify subsequent pancreatic cancer diagnoses.

During that time, 0.63% (38/6,064) of the patients developed pancreatic cancer. Patients were more likely to develop pancreatic cancer if they had larger PCLs, if they were 70 years of age or older, and if they showed ectasia (dilation) of the main pancreatic duct. Importantly, 26.3% (10/38) of the cancers were diagnosed more than five years after the patients' PCLs were initially detected, meaning that long-term monitoring of patients with low-risk PCLs could reduce missed or delayed pancreatic cancer diagnoses.

Importantly, a quarter of cancers developed after five years of follow-up, and nearly a third of cancers didn't even develop in the cyst, arising elsewhere in the pancreas, findings that should be incorporated into surveillance strategies. Our findings will support radiologists, gastroenterologists, pancreatic surgeons, and primary care providers in making earlier pancreatic cancer diagnoses in patients with low-risk pancreatic cysts."

Arya Haj Mirzaian, MD, MPH, first author, Mass General Brigham Department of Radiology

"Informed by the results of this study, imaging findings should be tightly integrated into a multi-disciplinary surveillance plan for each patient with low-risk PCL to reduce diagnostic error and patient harm associated with missed or delayed pancreatic cancer diagnosis," said co-author Avinash R. Kambadakone, MD, FRCR, Chief of Abdominal Radiology at Mass General Brigham.