Mass General Brigham study of more than 6,000 patients highlights the need for long-term personalized surveillance strategies
Catching pancreatic cancer early can increase the five-year survival rate from 15% to 80%. Patients with pancreatic cysts, frequently detected during unrelated abdominal CT or MRI imaging, can develop malignant pancreatic cancers. In a new study, Mass General Brigham investigators showed that patients with low-risk pancreatic cystic lesions (PCLs) have approximately 14 times higher risk of developing pancreatic cancer than the general population. They found that patients with larger low-risk cysts and older patients, particularly those over 70 years of age, were at greater risk for cancer. The results are published in JAMA Network Open.
"Our study underscores the need for long-term personalized surveillance strategies for patients with incidentally discovered low-risk pancreatic cysts," said senior author Ramin Khorasani MD, MPH , the director and co-founder of the Center for Evidence-Based Imaging , Radiology Quality Vice Chair and Assistant Chief Medical Officer at Mass General Brigham. "This approach could enable earlier detection of pancreatic cancer, when treatment is more likely to succeed."
Using abdominal imaging (MRI or CT scans) from 499,631 patients who were seen at Mass General Brigham between 2009 and 2021, the researchers identified 6,064 patients with low-risk PCLs. They followed these patients for an average of 3.3 years after the initial PCL detection to identify subsequent pancreatic cancer diagnoses.
During that time, 0.63% (38/6,064) of the patients developed pancreatic cancer. Patients were more likely to develop pancreatic cancer if they had larger PCLs, if they were 70 years of age or older, and if they showed ectasia (dilation) of the main pancreatic duct. Importantly, 26.3% (10/38) of the cancers were diagnosed more than five years after the patients' PCLs were initially detected, meaning that long-term monitoring of patients with low-risk PCLs could reduce missed or delayed pancreatic cancer diagnoses.
"Importantly, a quarter of cancers developed after five years of follow-up, and nearly a third of cancers didn't even develop in the cyst, arising elsewhere in the pancreas, findings that should be incorporated into surveillance strategies," said first author Arya Haj Mirzaian, MD, MPH, of the Mass General Brigham Department of Radiology . "Our findings will support radiologists, gastroenterologists, pancreatic surgeons, and primary care providers in making earlier pancreatic cancer diagnoses in patients with low-risk pancreatic cysts."
"Informed by the results of this study, imaging findings should be tightly integrated into a multi-disciplinary surveillance plan for each patient with low-risk PCL to reduce diagnostic error and patient harm associated with missed or delayed pancreatic cancer diagnosis," said co-author Avinash R. Kambadakone, MD, FRCR, Chief of Abdominal Radiology at Mass General Brigham.
Authorship: In addition to Khorasani, Haj Mirzaian, and Kambadakone, Mass General Brigham co-authors include Nooshin Abbasi, Ronilda Lacson, Yasmin Hernandez-Barco, David X Jin, Kunal Jajoo, and David W. Bates.
Disclosures: Kambadakone reported receiving grants from GE Healthcare and grants from PanCAN outside the submitted work. Lacson reported receiving grants from the Agency for Healthcare Research and Quality during the conduct of the study. Hernandez-Barco reported receiving personal fees from Nestle, Amgen, Sanofi, and Zenasbio outside the submitted work. Bates reported holding equity in ValeraHealth, Clew, and MDClone; receiving personal fees and equity from AESOP, FeelBetter, Guided Clinical Solutions; and receiving personal
fees from Relyens during the conduct of the study as well as holding a patent for PHC-028654 licensed to
Brigham and Women's Hospital outside the submitted work.
Paper cited: Haj Mirzaian, A et al. "Pancreatic Cancer Risk in Patients with Low-Risk Cystic Lesions" JAMA Network Open DOI: 10.1001/jamanetworkopen.2026.13808
