SNFGE SNFGE
 
Thématique :
- Pancréas/Voies biliaires
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Vinciane REBOURS
Coup de coeur :
 
 
Clinical Gastroenterology and Hepatology
  2019/01  
 
  2019 Jan;17(1):41-53.  
  doi: 10.1016/j.cgh.2018.04.065.  
 
  Diagnostic Yield From Screening Asymptomatic Individuals at High Risk for Pancreatic Cancer: A Meta-analysis of Cohort Studies  
 
  Corral JE, Mareth KF, Riegert-Johnson DL, Das A, Wallace MB  
  https://www.ncbi.nlm.nih.gov/pubmed/29775792  
 
 

Abstract

BACKGROUND & AIMS:

There have been few studies of abdominal imaging screening of individuals at high risk for pancreatic cancer (based on family history or genetic variants). We performed a meta-analysis of prospective cohort studies to determine the diagnostic yield and outcomes of abdominal imaging screening for asymptomatic individuals at high risk.

METHODS:

Through a systematic review of multiple electronic databases and conference proceedings through July 2017, we identified prospective cohort studies (>20 patients) of asymptomatic adults determined to be at high-risk of pancreatic cancer (lifetime risk >5%, including specific genetic-associated conditions) who were screened by endoscopic ultrasound (EUS) and/or magnetic resonance imaging (MRI) to detect pancreatic lesions. Our primary outcome was identification of high-risk pancreatic lesions (high-grade pancreatic intraepithelial neoplasia, high-grade dysplasia, or adenocarcinoma) at initial screening, and overall incidence during follow up. Summary estimates were reported as incidence rates per 100 patient-years.

RESULTS:

We identified 19 studies comprising 7085 individuals at high risk for pancreatic cancer; of these, 1660 patients were evaluated by EUS and/or MRI. Fifty-nine high-risk lesions were identified (43 adenocarcinomas: 28 during the initial exam and 15 during follow-up surveillance) and 257 patients underwent pancreatic surgery. Based on our meta-analysis, the overall diagnostic yield screening for high-risk pancreatic lesions was 0.74 (95% CI, 0.33-1.14), with moderate heterogeneity among studies. The number needed to screen to identify 1 patient with a high-risk lesion was 135 (95% CI, 88-303). The diagnostic yield was similar for patients with different genetic features that increased risk, and whether patients were screened by EUS or MRI.

CONCLUSIONS:

Based on meta-analysis, 135 patients at high-risk for pancreatic cancer must be screened to identify 1 patient with a high-risk pancreatic lesion. Further studies are needed to determine whether screening reduces mortality and is cost effectiveness for individuals at high-risk of pancreatic cancer.

 

  
Question posée
 
Méta-analyse d’études prospectives pour le dépistage des patients à haut risque de cancers du pancréas : quel est le taux de lésions mises en évidence ?
  
Question posée
 
19 études retenues, soient 7085 individus à haut risque de cancers du pancréas. Parmi ces individus, 1660 patients étaient dépistés régulièrement par EUS et/ou IRM. 55 lésions étaient trouvées dont 43 adénocarcinomes (28 lors de l’examen initial et 15 au cours du suivi). 257 patients ont été opérés. Le rendement diagnostique global du dépistage de lésions pancréatiques à haut risque était 0.74 (95% CI, 0.33–1.14). Pour trouver une lésion à haut risque, il faut dépister 135 patients (95% CI, 88–303). Le rendement était similaire si le dépistage était fait par IRM ou EUS.
  
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