Screening for pancreatic cancer in a high-risk population with serum CA 19-9 and targeted EUS: a feasibility study

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• 作者：Richard Zubarik MD^a ; ; Stuart R. Gordon MD^d ; Steven D. Lidofsky MD ; PhD^a ; Scott R. Anderson MD^b ; J. Marc Pipas MD^e ; Gary Badger MS^c ; Eric Ganguly MD^a ; James Vecchio MD^a
• 刊名：Gastrointestinal Endoscopy
• 出版年：2011
• 出版时间：July 2011
• 年：2011
• 卷：74
• 期：1
• 页码：87-95
• 全文大小：1637 K

文摘

Background

Earlier detection of pancreatic adenocarcinoma is needed.

Objective

To determine whether early pancreatic neoplasia can be detected in a high-risk population by using CA 19-9 followed by targeted EUS.

Design

Prospective cohort study.

Setting

Two academic medical centers.

Patients

Eligible patients met age criteria and had at least 1 first-degree relative with pancreatic adenocarcinoma.

Interventions

A serum CA 19-9 was performed on all patients. EUS was performed if the CA 19-9 level was elevated. FNA of identified lesions was performed. Patients with pancreatic cancer detected by using this screening protocol were compared with patients presenting off-protocol for staging data. Medicare reimbursement rates were used to derive cost data.

Main Outcome Measurements

Detection of early pancreatic neoplasia.

Results

A total of 546 patients were enrolled. CA 19-9 was elevated in 27 patients (4.9 % , 95 % CI, 3.2 % -7.1 % ). Neoplastic or malignant findings were detected in 5 patients (0.9 % , 95 % CI, 0.3 % -2.1 % ), and pancreatic adenocarcinoma in 1 patient (0.2 % , 95 % CI, 0.005 % -1.02 % ). The patient with pancreatic cancer detected as part of this protocol was 1 of 2 patients presenting to the University of Vermont with stage 1 cancer. The cost to detect 1 pancreatic neoplasia was $8431. The cost to detect 1 pancreatic adenocarcinoma was $41,133.

Limitations

The sample size is adequate only to demonstrate the feasibility of this approach.

Conclusions

Potentially curative pancreatic adenocarcinoma can be identified with this screening protocol. Stage 1 pancreatic cancer is more likely to be detected by using this screening protocol than by using standard means of detection.