Table 2.
Summary of consensus statements for the management of high risk individuals
| Who should be screened? | |
|---|---|
| Statements | |
| A1 | Individuals with three or more affected blood relatives, with at least one affected FDR, should be considered for screening. |
| A2 | Individuals with at least two affected FDRs with PC, with at least one affected FDR, should be considered for screening once they reach a certain age. |
| A3 | Individuals with two or more affected blood relatives with PC, with at least one affected FDR, should be considered for screening. |
| A4 | All patients with Peutz–Jeghers syndrome should be screened, regardless of family history of PC. |
| A5 | p16 carriers with one affected FDR should be considered for screening. |
| A6 | BRCA2 mutation carriers with one affected FDR should be considered for screening. |
| A7 | BRCA2 mutation carriers with two affected family members (no FDR) with PC should be considered for screening. |
| A8 | PALB2 mutation carriers with one affected FDR should be considered for screening. |
| A9 | Mismatch repair gene mutation carriers (Lynch syndrome) with one affected FDR should be considered for screening. |
| How should high-risk individuals be screened? | |
| Statements | |
| B1 | Initial screening should include (multiple answers allowed): EUS 83.7%, MRI/MRCP 73.5%, CT 26.5%, abdominal ultrasound 14.3%, ERCP 2.0%. |
| B2 | When previous screening did not detect an abnormality that met criteria for shortening of the interval or surgical resection, follow-up screening should include (multiple answers allowed): EUS 79.6% MRI/MRCP 69.4%, CT 22.4%, abdominal ultrasound 4.1%, ERCP 2.0%. |
| B3 | Standardised nomenclature should be used to define chronic pancreatitis-like abnormalities. |
| B4 | Whenever a cystic lesion is detected, an additional ERCP should not be performed. |
| B5 | Patients with a cystic lesion without worrisome features for malignancy should have an imaging test after 6–12 months. |
| B6 | When a solid lesion is detected, CT should also be performed. |
| B7 | When a solid lesion is detected, ERCP should not be performed. |
| B8 | When a solid lesion is detected at baseline with an indeterminate diagnosis and the patient is not referred for immediate surgery, imaging should be repeated after 3 months. |
| B9 | When a new solid lesion is detected at follow-up with an indeterminate diagnosis and the patient is not referred for immediate surgery, imaging should be repeated after 3 months. |
| B10 | If an indeterminate main pancreatic duct stricture without a mass is detected, repeat imaging should be performed within 3 months. |
| When should surgery be performed? | |
| Statements | |
| C1 | Screening should only be offered to individuals who are candidates for surgery. |
| C2 | Pancreatic resections should be performed at specialty centres (taking into account volume, morbidity and mortality rates and expertise available). |
| C3 | Intraoperatively, further pancreatectomy (up to a possible total) should be performed in patients with otherwise reasonable life expectancy to achieve R0 resection of cancer. |
| C4 | Intraoperatively, further pancreatectomy (up to a possible total) should not be performed in a patient with otherwise reasonable life expectancy and no cancer but with unifocal PanIN-2 in the resected specimen but not at the margin. |
| C5 | Postoperatively, further pancreatectomy (up to a possible total) should be not performed in patients with otherwise reasonable life expectancy in a patient without cancer in the resected specimen but with PanIN-2 at margin. |
| C6 | Postoperatively, further pancreatectomy (up to possible total) should be not be performed in patients with otherwise reasonable life expectancy in a patient who did not have cancer but had unifocal PanIN-2 in the resected specimens but not at the margin. |
| C7 | Postoperatively, further pancreatectomy (up to a possible total) should be not performed in patients with otherwise reasonable life expectancy in a patient without cancer but who has multifocal PanIN-2 in the resected specimens but not at the margin. |
| What are the goals of screening? What outcome(s) would be considered a ‘success’? | |
| Statements | |
| D1 | Resectable carcinoma is a potential target for early detection and treatment. |
| D2 | PanINs are a potential target for early detection and treatment. |
| D3 | IPMNs are a potential target for early detection and treatment. |
| D4 | Detection and treatment of multifocal PanIN-3 should be considered a success of a screening/surveillance programme. |
| D5 | Detection and treatment of IPMNs with high-grade dysplasia should be considered a success of a screening/surveillance programme. |
| D6 | Detection and treatment of invasive cancer-T1N0M0 detected at baseline should be considered a success of a screening programme. |
| D7 | Treatment of invasive cancer-T1N0M0 detected at follow-up should be considered a success of a screening programme. |
| D8 | Detection and treatment of invasive cancer >T1N0M0 resectable with margins negative at baseline, should be considered a success of a screening programme. |
ERCP, endoscopic retrograde cholangiopancreatography; EUS, endoscopic ultrasonography; FDR, first-degree relative; IPMN, intraductal papillary mucinous neoplasm; MRCP, magnetic resonance cholangiopancreatography; PC, pancreatic cancer; PanIN, pancreatic intraepithelial neoplasia.