MRI May Aid Early Pancreatic Cancer Detection in Diabetes
MRI-based screening in patients older than 50 years with new-onset or deteriorating diabetes detected stage IB pancreatic cancer in a patient with deteriorating diabetes, highlighting the need for targeted screening in this high-risk population.
METHODOLOGY:
New-onset diabetes in patients older than 50 years was found to increase the risk for pancreatic cancer by six- to eight-fold, and recent evidence suggests that the deterioration of diabetes in individuals with stable, long-standing disease may also be an indicator of subclinical pancreatic cancer.
Researchers conducted the PANDOME study to evaluate the effectiveness and safety of MRI-based screening for the early detection of pancreatic cancer in patients with new-onset diabetes (n = 97; median age, 61 years; 63.9% women) or deteriorating diabetes (n = 12; median age, 68 years; 58.3% women).
New-onset diabetes was defined as elevated A1c levels within the past 12 months, whereas deteriorating diabetes was defined as long-standing diabetes (> 2 years) with a > 2% increase in A1c levels over the past 6 months not linked to weight gain or diabetes medication noncompliance.
All patients underwent MRI/cholangiopancreatography, blood biobanking, and anxiety/depression monitoring; MRI results were scored as normal, benign-abnormal, suspicious, or incidental findings.
TAKEAWAY:
Compared with patients with new-onset diabetes, those with deteriorating diabetes had significantly higher A1c levels (P = .02), greater weight loss (P = .0038), and increased insulin requirements (P < .0001).
Among 109 participants, more than 50% had small cystic lesions with an average size of 6 mm, prompting seven endoscopic ultrasound procedures — four of which required biopsies. Of the four pancreatic biopsies performed, one revealed stage IB pancreatic ductal adenocarcinoma in a patient with deteriorating diabetes.
Extra-pancreatic incidental findings were detected in 8.2% of cases, with two requiring biopsies, revealing one new diagnosis of follicular lymphoma and one diagnosis of recurrent lymphoma.
According to the Enriching New-Onset Diabetes for Pancreatic Cancer score — where a high-risk score predicts a 3.6% probability of pancreatic cancer within 3 years — the deteriorating diabetes group had a higher proportion of high-risk individuals than the new-onset diabetes group (75% vs 35.6%).
IN PRACTICE:
'Preliminary results from the PANDOME study support further MRI-based PC [pancreatic cancer] screening research efforts in individuals with NOD [new-onset diabetes] and DD [deteriorating diabetes],' the authors concluded.
SOURCE:
This study was led by Richard Frank, MD, Division of Hematology/Oncology, Nuvance Health, Norwalk, Connecticut. It was published online in The Journal of Clinical Endocrinology & Metabolism.
LIMITATIONS:
T his study faced challenges with low accrual rates due to healthcare network realignments and high declination rates by potential participants. Selection bias potentially led to lower detection rates, as most participants were referred by primary care physicians or endocrinologists. Moreover, the majority of participants were White individuals (83%), despite higher pancreatic cancer risk among Black populations, limiting generalizability.
DISCLOSURES:
This study received support from a Tribute to Pamela/The Naughton Family Fund, the Rallye for Pancreatic Cancer, Pacific Crest Trail for Pancreatic Cancer, and the Glenn W. Bailey Foundation. The authors declared no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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