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Erschienen in: Die Innere Medizin 4/2022

02.03.2022 | Diagnostik in der Gastroenterologie | CME

Diagnostik und klinisches Management prämaligner Erkrankungen des Pankreas

verfasst von: S. M. Buchholz, C. Ammer-Herrmenau, V. Ellenrieder, Prof. Dr. Dr. A. Neesse

Erschienen in: Die Innere Medizin | Ausgabe 4/2022

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Zusammenfassung

Das Pankreaskarzinom gehört zu den aggressivsten soliden Tumoren und hat weiterhin eine sehr schlechte Prognose. Neben dem schlechten Ansprechen auf eine Systemtherapie macht die späte Diagnosestellung eine kurative Behandlung häufig unmöglich. Daher sind die Identifikation von Risikopatienten und deren regelmäßige Screenings der vielversprechendste Ansatz zur Verbesserung der Prognose. Neoplastische Pankreaszysten und chronische Pankreatitiden können das Risiko einer Tumorentwicklung deutlich erhöhen. Auch familiäre Syndrome und Keimbahnmutationen bergen ein erhöhtes Risiko zur Entwicklung eines Pankreaskarzinoms. In diesem Beitrag wird ein Überblick über die verschiedenen prämalignen Erkrankungen des Pankreas gegeben. Insbesondere werden die Wertigkeit verschiedener bildgebenden Modalitäten wie Magnetresonanztomographie und Endosonographie diskutiert sowie die Screeningintervalle und Indikationen für eine chirurgische Versorgung dargelegt.
Literatur
1.
Zurück zum Zitat Rahib L, Smith BD, Aizenberg R et al (2014) Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res 74:2913–2921 PubMedCrossRef Rahib L, Smith BD, Aizenberg R et al (2014) Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res 74:2913–2921 PubMedCrossRef
2.
Zurück zum Zitat Kromrey ML, Bulow R, Hubner J et al (2018) Prospective study on the incidence, prevalence and 5‑year pancreatic-related mortality of pancreatic cysts in a population-based study. Gut 67:138–145 PubMedCrossRef Kromrey ML, Bulow R, Hubner J et al (2018) Prospective study on the incidence, prevalence and 5‑year pancreatic-related mortality of pancreatic cysts in a population-based study. Gut 67:138–145 PubMedCrossRef
3.
Zurück zum Zitat Vege SS, Ziring B, Jain R et al (2015) American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 148:819–822 (quiz e812–e813) PubMedCrossRef Vege SS, Ziring B, Jain R et al (2015) American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 148:819–822 (quiz e812–e813) PubMedCrossRef
4.
Zurück zum Zitat Tanaka M, Fernandez-Del Castillo C, Kamisawa T et al (2017) Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 17:738–753 PubMedCrossRef Tanaka M, Fernandez-Del Castillo C, Kamisawa T et al (2017) Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 17:738–753 PubMedCrossRef
5.
Zurück zum Zitat European Study Group on Cystic Tumours of The P (2018) European evidence-based guidelines on pancreatic cystic neoplasms. Gut 67:789–804 CrossRef European Study Group on Cystic Tumours of The P (2018) European evidence-based guidelines on pancreatic cystic neoplasms. Gut 67:789–804 CrossRef
7.
Zurück zum Zitat Van Huijgevoort NCM, Del Chiaro M, Wolfgang CL et al (2019) Diagnosis and management of pancreatic cystic neoplasms: current evidence and guidelines. Nat Rev Gastroenterol Hepatol 16:676–689 PubMedCrossRef Van Huijgevoort NCM, Del Chiaro M, Wolfgang CL et al (2019) Diagnosis and management of pancreatic cystic neoplasms: current evidence and guidelines. Nat Rev Gastroenterol Hepatol 16:676–689 PubMedCrossRef
8.
Zurück zum Zitat Ogawa H, Itoh S, Ikeda M et al (2008) Intraductal papillary mucinous neoplasm of the pancreas: assessment of the likelihood of invasiveness with multisection CT. Radiology 248:876–886 PubMedCrossRef Ogawa H, Itoh S, Ikeda M et al (2008) Intraductal papillary mucinous neoplasm of the pancreas: assessment of the likelihood of invasiveness with multisection CT. Radiology 248:876–886 PubMedCrossRef
9.
Zurück zum Zitat Polkowski M, Jenssen C, Kaye P et al (2017) Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline—March 2017. Endoscopy 49:989–1006 PubMedCrossRef Polkowski M, Jenssen C, Kaye P et al (2017) Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline—March 2017. Endoscopy 49:989–1006 PubMedCrossRef
10.
Zurück zum Zitat Mccarty TR, Garg R, Rustagi T (2021) Pancreatic cyst fluid glucose in differentiating mucinous from nonmucinous pancreatic cysts: a systematic review and meta-analysis. Gastrointest Endosc 94:698–712.e696 PubMedCrossRef Mccarty TR, Garg R, Rustagi T (2021) Pancreatic cyst fluid glucose in differentiating mucinous from nonmucinous pancreatic cysts: a systematic review and meta-analysis. Gastrointest Endosc 94:698–712.e696 PubMedCrossRef
11.
Zurück zum Zitat Hoda RS, Lu R, Arpin RN 3rd et al (2018) Risk of malignancy in pancreatic cysts with cytology of high-grade epithelial atypia. Cancer Cytopathol 126:773–781 PubMedCrossRef Hoda RS, Lu R, Arpin RN 3rd et al (2018) Risk of malignancy in pancreatic cysts with cytology of high-grade epithelial atypia. Cancer Cytopathol 126:773–781 PubMedCrossRef
12.
Zurück zum Zitat Singhi AD, Mcgrath K, Brand RE et al (2018) Preoperative next-generation sequencing of pancreatic cyst fluid is highly accurate in cyst classification and detection of advanced neoplasia. Gut 67:2131–2141 PubMedCrossRef Singhi AD, Mcgrath K, Brand RE et al (2018) Preoperative next-generation sequencing of pancreatic cyst fluid is highly accurate in cyst classification and detection of advanced neoplasia. Gut 67:2131–2141 PubMedCrossRef
13.
Zurück zum Zitat Kamata K, Kitano M, Omoto S et al (2016) Contrast-enhanced harmonic endoscopic ultrasonography for differential diagnosis of pancreatic cysts. Endoscopy 48:35–41 PubMed Kamata K, Kitano M, Omoto S et al (2016) Contrast-enhanced harmonic endoscopic ultrasonography for differential diagnosis of pancreatic cysts. Endoscopy 48:35–41 PubMed
14.
Zurück zum Zitat Seo N, Byun JH, Kim JH et al (2016) Validation of the 2012 international consensus guidelines using computed tomography and magnetic resonance imaging: branch duct and main duct intraductal papillary mucinous neoplasms of the pancreas. Ann Surg 263:557–564 PubMedCrossRef Seo N, Byun JH, Kim JH et al (2016) Validation of the 2012 international consensus guidelines using computed tomography and magnetic resonance imaging: branch duct and main duct intraductal papillary mucinous neoplasms of the pancreas. Ann Surg 263:557–564 PubMedCrossRef
15.
Zurück zum Zitat Shin SH, Han DJ, Park KT et al (2010) Validating a simple scoring system to predict malignancy and invasiveness of intraductal papillary mucinous neoplasms of the pancreas. World J Surg 34:776–783 PubMedCrossRef Shin SH, Han DJ, Park KT et al (2010) Validating a simple scoring system to predict malignancy and invasiveness of intraductal papillary mucinous neoplasms of the pancreas. World J Surg 34:776–783 PubMedCrossRef
16.
Zurück zum Zitat Overbeek KA, Alblas M, Gausman V et al (2019) Development of a stratification tool to identify pancreatic intraductal papillary mucinous neoplasms at lowest risk of progression. Aliment Pharmacol Ther 50:789–799 PubMedPubMedCentralCrossRef Overbeek KA, Alblas M, Gausman V et al (2019) Development of a stratification tool to identify pancreatic intraductal papillary mucinous neoplasms at lowest risk of progression. Aliment Pharmacol Ther 50:789–799 PubMedPubMedCentralCrossRef
17.
Zurück zum Zitat Petrone MC, Magnoni P, Pergolini I et al (2018) Long-term follow-up of low-risk branch-duct IPMNs of the pancreas: is main pancreatic duct dilatation the most worrisome feature? Clin Transl Gastroenterol 9:158 PubMedPubMedCentralCrossRef Petrone MC, Magnoni P, Pergolini I et al (2018) Long-term follow-up of low-risk branch-duct IPMNs of the pancreas: is main pancreatic duct dilatation the most worrisome feature? Clin Transl Gastroenterol 9:158 PubMedPubMedCentralCrossRef
18.
Zurück zum Zitat Thompson LD, Becker RC, Przygodzki RM et al (1999) Mucinous cystic neoplasm (mucinous cystadenocarcinoma of low-grade malignant potential) of the pancreas: a clinicopathologic study of 130 cases. Am J Surg Pathol 23:1–16 PubMedCrossRef Thompson LD, Becker RC, Przygodzki RM et al (1999) Mucinous cystic neoplasm (mucinous cystadenocarcinoma of low-grade malignant potential) of the pancreas: a clinicopathologic study of 130 cases. Am J Surg Pathol 23:1–16 PubMedCrossRef
19.
Zurück zum Zitat Postlewait LM, Ethun CG, Mcinnis MR et al (2017) Association of preoperative risk factors with malignancy in pancreatic mucinous cystic neoplasms: a multicenter study. JAMA Surg 152:19–25 PubMedPubMedCentralCrossRef Postlewait LM, Ethun CG, Mcinnis MR et al (2017) Association of preoperative risk factors with malignancy in pancreatic mucinous cystic neoplasms: a multicenter study. JAMA Surg 152:19–25 PubMedPubMedCentralCrossRef
20.
Zurück zum Zitat Ohtsuka T, Nakamura M, Hijioka S et al (2020) Prediction of the probability of malignancy in mucinous cystic neoplasm of the pancreas with ovarian-type stroma: a nationwide multicenter study in Japan. Pancreas 49:181–186 PubMedCrossRef Ohtsuka T, Nakamura M, Hijioka S et al (2020) Prediction of the probability of malignancy in mucinous cystic neoplasm of the pancreas with ovarian-type stroma: a nationwide multicenter study in Japan. Pancreas 49:181–186 PubMedCrossRef
21.
Zurück zum Zitat Jais B, Rebours V, Malleo G et al (2016) Serous cystic neoplasm of the pancreas: a multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club (European Study Group on Cystic Tumors of the Pancreas). Gut 65:305–312 PubMedCrossRef Jais B, Rebours V, Malleo G et al (2016) Serous cystic neoplasm of the pancreas: a multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club (European Study Group on Cystic Tumors of the Pancreas). Gut 65:305–312 PubMedCrossRef
22.
Zurück zum Zitat La Rosa S, Bongiovanni M (2020) Pancreatic solid pseudopapillary neoplasm: key pathologic and genetic features. Arch Pathol Lab Med 144:829–837 PubMedCrossRef La Rosa S, Bongiovanni M (2020) Pancreatic solid pseudopapillary neoplasm: key pathologic and genetic features. Arch Pathol Lab Med 144:829–837 PubMedCrossRef
23.
Zurück zum Zitat Falconi M, Eriksson B, Kaltsas G et al (2016) ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors. Neuroendocrinology 103:153–171 PubMedCrossRef Falconi M, Eriksson B, Kaltsas G et al (2016) ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors. Neuroendocrinology 103:153–171 PubMedCrossRef
24.
Zurück zum Zitat Partelli S, Cirocchi R, Crippa S et al (2017) Systematic review of active surveillance versus surgical management of asymptomatic small non-functioning pancreatic neuroendocrine neoplasms. Br J Surg 104:34–41 PubMedCrossRef Partelli S, Cirocchi R, Crippa S et al (2017) Systematic review of active surveillance versus surgical management of asymptomatic small non-functioning pancreatic neuroendocrine neoplasms. Br J Surg 104:34–41 PubMedCrossRef
25.
Zurück zum Zitat Ammer-Herrmenau C, Ellenrieder V, Neesse A (2021) Diagnosis and treatment of chronic pancreatitis. Dtsch Med Wochenschr 146:237–245 PubMed Ammer-Herrmenau C, Ellenrieder V, Neesse A (2021) Diagnosis and treatment of chronic pancreatitis. Dtsch Med Wochenschr 146:237–245 PubMed
26.
27.
Zurück zum Zitat Beyer G, Hoffmeister A, Michl P et al (2021) S3-Leitlinie Pankreatitis Beyer G, Hoffmeister A, Michl P et al (2021) S3-Leitlinie Pankreatitis
28.
Zurück zum Zitat Levy P, Mathurin P, Roqueplo A et al (1995) A multidimensional case-control study of dietary, alcohol, and tobacco habits in alcoholic men with chronic pancreatitis. Pancreas 10:231–238 PubMedCrossRef Levy P, Mathurin P, Roqueplo A et al (1995) A multidimensional case-control study of dietary, alcohol, and tobacco habits in alcoholic men with chronic pancreatitis. Pancreas 10:231–238 PubMedCrossRef
29.
Zurück zum Zitat Lin Y, Tamakoshi A, Hayakawa T et al (2001) Associations of alcohol drinking and nutrient intake with chronic pancreatitis: findings from a case-control study in Japan. Am J Gastroenterol 96:2622–2627 PubMedCrossRef Lin Y, Tamakoshi A, Hayakawa T et al (2001) Associations of alcohol drinking and nutrient intake with chronic pancreatitis: findings from a case-control study in Japan. Am J Gastroenterol 96:2622–2627 PubMedCrossRef
30.
Zurück zum Zitat Lohr JM, Dominguez-Munoz E, Rosendahl J et al (2017) United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United European Gastroenterol J 5:153–199 PubMedPubMedCentralCrossRef Lohr JM, Dominguez-Munoz E, Rosendahl J et al (2017) United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United European Gastroenterol J 5:153–199 PubMedPubMedCentralCrossRef
31.
Zurück zum Zitat Whitcomb DC, Gorry MC, Preston RA et al (1996) Hereditary pancreatitis is caused by a mutation in the cationic trypsinogen gene. Nat Genet 14:141–145 PubMedCrossRef Whitcomb DC, Gorry MC, Preston RA et al (1996) Hereditary pancreatitis is caused by a mutation in the cationic trypsinogen gene. Nat Genet 14:141–145 PubMedCrossRef
32.
Zurück zum Zitat Shelton CA, Umapathy C, Stello K et al (2018) Hereditary pancreatitis in the United States: survival and rates of pancreatic cancer. Am J Gastroenterol 113:1376 PubMedPubMedCentralCrossRef Shelton CA, Umapathy C, Stello K et al (2018) Hereditary pancreatitis in the United States: survival and rates of pancreatic cancer. Am J Gastroenterol 113:1376 PubMedPubMedCentralCrossRef
33.
Zurück zum Zitat Ooi CY, Durie PR (2012) Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations in pancreatitis. J Cyst Fibros 11:355–362 PubMedCrossRef Ooi CY, Durie PR (2012) Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations in pancreatitis. J Cyst Fibros 11:355–362 PubMedCrossRef
34.
Zurück zum Zitat Rosendahl J, Landt O, Bernadova J et al (2013) CFTR, SPINK1, CTRC and PRSS1 variants in chronic pancreatitis: is the role of mutated CFTR overestimated? Gut 62:582–592 PubMedCrossRef Rosendahl J, Landt O, Bernadova J et al (2013) CFTR, SPINK1, CTRC and PRSS1 variants in chronic pancreatitis: is the role of mutated CFTR overestimated? Gut 62:582–592 PubMedCrossRef
35.
Zurück zum Zitat Keller J, Layer P (2008) Idiopathic chronic pancreatitis. Best Pract Res Clin Gastroenterol 22:105–113 PubMedCrossRef Keller J, Layer P (2008) Idiopathic chronic pancreatitis. Best Pract Res Clin Gastroenterol 22:105–113 PubMedCrossRef
36.
Zurück zum Zitat Kirkegard J, Mortensen FV, Cronin-Fenton D (2017) Chronic pancreatitis and pancreatic cancer risk: a systematic review and meta-analysis. Am J Gastroenterol 112:1366–1372 PubMedCrossRef Kirkegard J, Mortensen FV, Cronin-Fenton D (2017) Chronic pancreatitis and pancreatic cancer risk: a systematic review and meta-analysis. Am J Gastroenterol 112:1366–1372 PubMedCrossRef
37.
Zurück zum Zitat Harinck F, Konings IC, Kluijt I et al (2016) A multicentre comparative prospective blinded analysis of EUS and MRI for screening of pancreatic cancer in high-risk individuals. Gut 65:1505–1513 PubMedCrossRef Harinck F, Konings IC, Kluijt I et al (2016) A multicentre comparative prospective blinded analysis of EUS and MRI for screening of pancreatic cancer in high-risk individuals. Gut 65:1505–1513 PubMedCrossRef
38.
Zurück zum Zitat Vasen H, Ibrahim I, Ponce CG et al (2016) Benefit of surveillance for pancreatic cancer in high-risk individuals: outcome of long-term prospective follow-up studies from three European Expert Centers. J Clin Oncol 34:2010–2019 PubMedCrossRef Vasen H, Ibrahim I, Ponce CG et al (2016) Benefit of surveillance for pancreatic cancer in high-risk individuals: outcome of long-term prospective follow-up studies from three European Expert Centers. J Clin Oncol 34:2010–2019 PubMedCrossRef
39.
40.
Zurück zum Zitat Goggins M, Overbeek KA, Brand R et al (2020) Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium. Gut 69:7–17 PubMedCrossRef Goggins M, Overbeek KA, Brand R et al (2020) Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium. Gut 69:7–17 PubMedCrossRef
41.
Zurück zum Zitat Mcwilliams RR, Rabe KG, Olswold C et al (2005) Risk of malignancy in first-degree relatives of patients with pancreatic carcinoma. Cancer 104:388–394 PubMedCrossRef Mcwilliams RR, Rabe KG, Olswold C et al (2005) Risk of malignancy in first-degree relatives of patients with pancreatic carcinoma. Cancer 104:388–394 PubMedCrossRef
42.
Zurück zum Zitat Jacobs EJ, Chanock SJ, Fuchs CS et al (2010) Family history of cancer and risk of pancreatic cancer: a pooled analysis from the Pancreatic Cancer Cohort Consortium (PanScan). Int J Cancer 127:1421–1428 PubMedPubMedCentralCrossRef Jacobs EJ, Chanock SJ, Fuchs CS et al (2010) Family history of cancer and risk of pancreatic cancer: a pooled analysis from the Pancreatic Cancer Cohort Consortium (PanScan). Int J Cancer 127:1421–1428 PubMedPubMedCentralCrossRef
43.
Zurück zum Zitat Canto MI, Almario JA, Schulick RD et al (2018) Risk of neoplastic progression in individuals at high risk for pancreatic cancer undergoing long-term surveillance. Gastroenterology 155:740–751 PubMedCrossRef Canto MI, Almario JA, Schulick RD et al (2018) Risk of neoplastic progression in individuals at high risk for pancreatic cancer undergoing long-term surveillance. Gastroenterology 155:740–751 PubMedCrossRef
Metadaten
Titel
Diagnostik und klinisches Management prämaligner Erkrankungen des Pankreas
verfasst von
S. M. Buchholz
C. Ammer-Herrmenau
V. Ellenrieder
Prof. Dr. Dr. A. Neesse
Publikationsdatum
02.03.2022
Verlag
Springer Medizin
Erschienen in
Die Innere Medizin / Ausgabe 4/2022
Print ISSN: 2731-7080
Elektronische ISSN: 2731-7099
DOI
https://doi.org/10.1007/s00108-022-01308-w

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