Volume 155, Issue 3, Pages 740-751.e2 (September 2018) Risk of Neoplastic Progression in Individuals at High Risk for Pancreatic Cancer Undergoing Long-term Surveillance  Marcia Irene Canto, Jose Alejandro Almario, Richard D. Schulick, Charles J. Yeo, Alison Klein, Amanda Blackford, Eun Ji Shin, Abanti Sanyal, Gayane Yenokyan, Anne Marie Lennon, Ihab R. Kamel, Elliot K. Fishman, Christopher Wolfgang, Matthew Weiss, Ralph H. Hruban, Michael Goggins  Gastroenterology  Volume 155, Issue 3, Pages 740-751.e2 (September 2018) DOI: 10.1053/j.gastro.2018.05.035 Copyright © 2018 AGA Institute Terms and Conditions

Gastroenterology 2018 155, 740-751. e2DOI: (10. 1053/j. gastro. 2018 Copyright © 2018 AGA Institute Terms and Conditions

Figure 1 Risk for neoplastic progression was significantly increased in (A) HRIs with worrisome features (radiologic progression) (P < .0001) (B) and those beginning screening at age > 60 years. Gastroenterology 2018 155, 740-751.e2DOI: (10.1053/j.gastro.2018.05.035) Copyright © 2018 AGA Institute Terms and Conditions

Figure 2 Cumulative risk (hazard) for neoplastic progression (PDAC, IPMN-HGD, or PanIN-3) for HRIs after baseline screening. Overall neoplastic progression rate was 1.6% per year. Gastroenterology 2018 155, 740-751.e2DOI: (10.1053/j.gastro.2018.05.035) Copyright © 2018 AGA Institute Terms and Conditions

Figure 3 Incident asymptomatic 7-mm pancreatic cancer detected after 10 years of surveillance, shown by arrows in (A) EUS image and (B) gross pathology section of the pancreatic body. (C) Final pathologic diagnosis was stage T1N0 moderately differentiated adenocarcinoma with negative margins (cytology smear from EUS-guided fine-needle aspiration). (D) Hematoxylin and eosin stain. Venous and perineural invasion were not identified. Gastroenterology 2018 155, 740-751.e2DOI: (10.1053/j.gastro.2018.05.035) Copyright © 2018 AGA Institute Terms and Conditions

Figure 4 Kaplan-Meier curves for overall survival for HRIs diagnosed with pancreatic neoplasms diagnosed by surgery or EUS-guided fine-needle aspiration. The group “Others” includes pathologically proven lower-grade pancreatic neoplasms that were not PDAC, IPMN-HGD, or PanIN-3 (IPMN with low-grade dysplasia or moderate-grade dysplasia, PanIN-2, PanNET, serous cystadenoma, pseudocyst). Gastroenterology 2018 155, 740-751.e2DOI: (10.1053/j.gastro.2018.05.035) Copyright © 2018 AGA Institute Terms and Conditions

Supplementary Figure 1 Cumulative risk (hazard) for radiologic progression over the 16-year study period for HRIs after baseline screening. Gastroenterology 2018 155, 740-751.e2DOI: (10.1053/j.gastro.2018.05.035) Copyright © 2018 AGA Institute Terms and Conditions

Supplementary Figure 2 Cumulative risk (hazard) for radiologic progression stratified by baseline age > 60 years (red upper curve) and ≤ 60 years (blue lower curve) (P = .0001). Gastroenterology 2018 155, 740-751.e2DOI: (10.1053/j.gastro.2018.05.035) Copyright © 2018 AGA Institute Terms and Conditions