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World J Clin Oncol. Feb 24, 2019; 10(2): 67-74
Published online Feb 24, 2019. doi: 10.5306/wjco.v10.i2.67
Pancreatic cancer screening in patients with presumed branch-duct intraductal papillary mucinous neoplasms
Yuichi Torisu, Kazuki Takakura, Yuji Kinoshita, Yoichi Tomita, Masanori Nakano, Masayuki Saruta
Yuichi Torisu, Kazuki Takakura, Yuji Kinoshita, Yoichi Tomita, Masanori Nakano, Masayuki Saruta, Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo 105-8461, Japan
Author contributions: Torisu Y and Takakura K wrote the manuscript; Kinoshita Y, Tomita Y and Nakano M critically appraised the manuscript; Saruta M formatted and edited the final manuscript.
Conflict-of-interest statement: The authors each declare no financial relationships to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yuichi Torisu, MD, PhD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo 105-8461, Japan. torisu@yb4.so-net.ne.jp
Telephone: +81-3-34331111 Fax: +81-3-34350569
Received: October 13, 2018
Peer-review started: October 15, 2018
First decision: November 28, 2018
Revised: December 8, 2018
Accepted: January 9, 2019
Article in press: January 10, 2019
Published online: February 24, 2019
Processing time: 134 Days and 17.8 Hours
Abstract

Because delayed diagnosis is one of the causes of poor prognosis in pancreatic ductal adenocarcinoma (PDAC), early detection is a key for overall improvement of prognosis. Towards this end, periodic screening is recommended for individuals considered high-risk for PDAC. Advances in diagnostic imaging modalities have increased the frequency of incidental findings of pancreatic cysts, including the intraductal papillary mucinous neoplasm (IPMN) - a major risk factor of PDAC, having 1% annual prevalence of concomitance with IPMN. Proper retainment of patients with IPMN and regular follow-up by routine imaging examination will likely improve early detection and better prognosis of PDAC. Unfortunately, current guidelines only address management of PDAC derived from IPMN and overlook PDAC concomitant with IPMN. Screening of patients with IPMN, by endoscopic ultrasonography (currently the most reliable modality for detecting small PDAC), may facilitate early detection of both IPMN-derived and -concomitant PDAC. Prospective studies to evaluate the usefulness of endoscopic ultrasonography in screening of IPMN-concomitant PDAC will also help in determining the optimal surveillance strategy for more widespread applications.

Keywords: Intraductal papillary mucinous neoplasm; Pancreatic ductal adenocarcinoma; Endoscopic ultrasonography; Screening; Early diagnosis

Core tip: Advances in diagnostic imaging modalities have increased the frequency of incidental findings of pancreatic cysts, including of the intraductal papillary mucinous neoplasm (IPMN) - a major risk factor of pancreatic ductal adenocarcinoma (PDAC). Proper retainment of patients with IPMN and regular follow-up by routine imaging examination will likely improve early detection and better prognosis of PDAC. Unfortunately, current guidelines only address management of PDAC derived from IPMN and overlook PDAC concomitant with IPMN. Screening of patients with IPMN, by endoscopic ultrasonography (currently the most reliable modality for detecting small PDAC), may facilitate early detection of both IPMN-derived and -concomitant PDAC.