SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
- Pancréas/Voies biliaires
- Cancers autres (hors CCR et CHC)
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Gut
  2016/09  
 
  2016 Sep;65(9):1505-13  
  doi:10.1136/gutjnl-2014-308008  
 
  A multicentre comparative prospective blinded analysis of EUS and MRI for screening of pancreatic cancer in high-risk individuals  
 
  Harinck F, Konings IC, Kluijt I, Poley JW, van Hooft JE, van Dullemen HM, Nio CY, Krak NC, Hermans JJ, Aalfs CM, Wagner A, Sijmons RH, Biermann K, van Eijck CH, Gouma DJ, Dijkgraaf MG, Fockens P, Bruno MJ; Dutch research group on pancreatic cancer surveillance in high-risk individuals.  
  http://gut.bmj.com/content/65/9/1505.abstract?sid=7b1cda41-9035-484f-a265-59248de3f5d8  
 
 

Objective
Endoscopic ultrasonography (EUS) and MRI are promising tests to detect precursors and early-stage pancreatic ductal adenocarcinoma (PDAC) in high-risk individuals (HRIs). It is unclear which screening technique is to be preferred. We aimed to compare the efficacy of EUS and MRI in their ability to detect clinically relevant lesions in HRI.

Design
Multicentre prospective study. The results of 139 asymptomatic HRI (>10-fold increased risk) undergoing first-time screening by EUS and MRI are described. Clinically relevant lesions were defined as solid lesions, main duct intraductal papillary mucinous neoplasms and cysts ≥10 mm. Results were compared in a blinded, independent fashion.

Results
Two solid lesions (mean size 9 mm) and nine cysts ≥10 mm (mean size 17 mm) were detected in nine HRI (6%). Both solid lesions were detected by EUS only and proved to be a stage I PDAC and a multifocal pancreatic intraepithelial neoplasia 2. Of the nine cysts ≥10 mm, six were detected by both imaging techniques and three were detected by MRI only. The agreement between EUS and MRI for the detection of clinically relevant lesions was 55%. Of these clinically relevant lesions detected by both techniques, there was a good agreement for location and size.

Conclusions
EUS and/or MRI detected clinically relevant pancreatic lesions in 6% of HRI. Both imaging techniques were complementary rather than interchangeable: contrary to EUS, MRI was found to be very sensitive for the detection of cystic lesions of any size; MRI, however, might have some important limitations with regard to the timely detection of solid lesions.

 
Question posée
 
Echoendoscopie vs IRM : quelle est le meilleur moyen de détection des lésions pancréatiques chez les patients à haut risque de cancer ?
 
Question posée
 
6% des patients avaient des lésions solides ou kystiques lors du premier examen. La corrélation entre échoendoscopie et IRM était seulement de 55%.
 
Commentaires

Ces techniques sont complémentaires, l’IRM étant plus sensible pour les lésions kystiques et l’échoendoscopie étant la seule méthode ayant diagnostiqué les lésions solides dans cette étude.

 
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