Elliot K. Fishman M.D.
Johns Hopkins Hospital

Click here to view this module as a video lecture.

Results: Of 2552 high-risk individuals under surveillance, 28 (1%) developed neoplastic progression to PC or high-grade dysplasia during follow-up (median 29 months after baseline, IQR 40). 46% (13/28) presented with a new lesion (median size 15 mm, range 7-57), a median of 11 months (IQR 8, range 3-17) after a prior examination, by which time 77% (10/13) had progressed beyond the pancreas. The other 54% (15/28) had neoplastic progression in a previously detected lesion (12 originally cystic, 2 indeterminate, 1 solid); 11 (73%) had PC progressed beyond the pancreas. The 12 patients with cysts had been followed for 21 months (IQR 15) and had a median growth of 5 mm/year (IQR 8). Successful early detection (as high-grade dysplasia or PC confined to the pancreas) was associated with resection of cystic lesions (versus solid or indeterminate lesions, OR 5.388, 95%CI 1.525-19.029) and small lesions (OR 0.890/mm, 95%CI 0.812-0.976). 
Timeline of development of pancreatic cancer and implications for successful early detection in high-risk individual
Overbeek KA et alOn behalf of the International Cancer of the Pancreas Screening Consortium
Gastroenterology (2021), doi: https://doi.org/10.1053/j.gastro.2021.10.014.

Background and aims: To successfully implement imaging-based pancreatic cancer (PC) surveillance, it is key to understand the timeline and morphological features of neoplastic progression. We aimed to investigate the progression to neoplasia from serial prediagnostic pancreatic imaging tests in high-risk individuals, and identify factors associated with successful early detection.
Methods: We retrospectively examined the development of pancreatic abnormalities in high-risk individuals who were diagnosed with PC and/or underwent pancreatic surgery in 16 international surveillance programs.
Conclusion: Nearly half of high-risk individuals developing high-grade dysplasia or PC have no prior lesions detected by imaging, yet present at an advanced stage. Progression can occur before the next scheduled annual examination. More sensitive diagnostic tools or a different management strategy for rapidly-growing cysts are needed.

Conclusion: Nearly half of high-risk individuals developing high-grade dysplasia or PC have no prior lesions detected by imaging, yet present at an advanced stage. Progression can occur before the next scheduled annual examination. More sensitive diagnostic tools or a different management strategy for rapidly-growing cysts are needed.
Timeline of development of pancreatic cancer and implications for successful early detection in high-risk individual
Overbeek KA et alOn behalf of the International Cancer of the Pancreas Screening Consortium
Gastroenterology (2021), doi: https://doi.org/10.1053/j.gastro.2021.10.014.

1980

• 4 images on 8 x 10 film
• 30-40 scan slices per case
• Acquisition time per study was 40-50 minutes (10 sec scan slides and 60 sec per slice reconstruction time)
• Limited resolution studies

1990

• 16 images on 14 x 17 film
• 50-100 scan slices per case
• Acquisition time per study was 30-40 minutes (5 sec scan per slice and 10 sec per slice reconstruction time)
• Limited resolution studies

2020

• Images reviewed on a computer (no film)
• 2000-4000 scan slices per case
• Acquisition time per study was 10 seconds or less with real time reconstruction (50 images /sec)
• High resolution studies

The key to pancreatic imaging is not thinner slices, more slices or minimal increase in resolution but analysis of the data using algorithms from computer graphics with advanced lighting models , AI including Radiomics and Deep Learning.

Drebin et al 1988

Kroes et al 2012

The range of visualizations in any case must change to visualize structures ranging from bone, to vasculature to muscle. Here is a case with IVDA and groin infection