Screening for Early Pancreatic Neoplasia in High-Risk Individuals: A Prospective Controlled Study  Marcia Irene Canto, Michael Goggins, Ralph H. Hruban, Gloria M. Petersen, Francis M. Giardiello, Charles Yeo, Elliott K. Fishman, Kieran Brune, Jennifer Axilbund, Constance Griffin, Syed Ali, Jeffrey Richman, Sanjay Jagannath, Sergey V. Kantsevoy, Anthony N. Kalloo  Clinical Gastroenterology and Hepatology  Volume 4, Issue 6, Pages 766-781 (June 2006) DOI: 10.1016/j.cgh.2006.02.005 Copyright © 2006 American Gastroenterological Association Terms and Conditions

Figure 1 Summary of screening methods for high-risk individuals. Clinical Gastroenterology and Hepatology 2006 4, 766-781DOI: (10.1016/j.cgh.2006.02.005) Copyright © 2006 American Gastroenterological Association Terms and Conditions

Figure 2 Screening CT scan (A) and EUS (B) image of patient 1 (Table 4) showing a small mass in the uncinate process of the pancreas (arrow). Pathologic examination of the Whipple resection specimen (C) showed this was an IPMN (left image), with carcinoma in situ (right image). Clinical Gastroenterology and Hepatology 2006 4, 766-781DOI: (10.1016/j.cgh.2006.02.005) Copyright © 2006 American Gastroenterological Association Terms and Conditions

Figure 3 Screening CT scan and EUS of patient 2 showing multiple cystic lesions on CT (A), and EUS (B) showed an irregular, thickened, main pancreatic duct in the tail dilated to 7.3 mm with 2 cystic lesions (one with a mural hypoechoic mural nodule of 4.2 mm). The pancreatogram (C) showed focal duct dilation in the tail. The distal pancreatectomy specimen also had multifocal PanIN, including PanIN-3 (D, left image; hematoxylin-eosin stain) with loss of basement membrane consistent with a possible microinvasive adenocarcinoma (D, right image). Clinical Gastroenterology and Hepatology 2006 4, 766-781DOI: (10.1016/j.cgh.2006.02.005) Copyright © 2006 American Gastroenterological Association Terms and Conditions

Figure 4 Serial radial EUS images (7.5 MHz) of patient 5 showing progression of a focally dilated pancreatic duct (A) at baseline, to a 10-mm cystic lesion 3 months later (B), to a larger 15-mm cystic lesion at 12 months (C). Clinical Gastroenterology and Hepatology 2006 4, 766-781DOI: (10.1016/j.cgh.2006.02.005) Copyright © 2006 American Gastroenterological Association Terms and Conditions

Figure 5 Endoscopic image of the major papilla of patient 6 (A) showing a “classic” fish-mouth appearance of IPMN with a gaping pancreatic duct orifice and mucin being extruded. EUS (B) showed a cystic lesion with a polypoid mural thickening. ERCP (C) image with a cystic, contrast-filled structure communicating with the main pancreatic duct in the pancreatic head, the typical appearance of a branch-type IPMN. This 1.4-cm lesion was not evident on preoperative CT scan. Gross specimen (D, left image) and microscopic image (D, right) of the resected benign IPMN-adenoma. Clinical Gastroenterology and Hepatology 2006 4, 766-781DOI: (10.1016/j.cgh.2006.02.005) Copyright © 2006 American Gastroenterological Association Terms and Conditions