Multiparametric endoscopic ultrasound for improved pancreatic cancer screening and characterization

PROJECT SUMMARY/ABSTRACT
Pancreatic cancer is one of the deadliest cancers while comprising only 3% of new cancer cases in the U.S.
each year. This is due to its advanced stage at diagnosis and resistance to standard treatment approaches.
Although population-based screening is not justified due to its low incidence, pancreatic cancer screening and
surveillance is recommended for high-risk individuals (HRIs) who have specific genetic syndromes and familial
predispositions that put them at risk for developing pancreatic cancer. The goal is to detect resectable, early-
stage pancreatic ductal adenocarcinoma (PDAC) and high-risk precursor lesions before malignant progression.
Magnetic resonance imaging and endoscopic ultrasonography (EUS) are the preferred screening modalities in
HRIs. EUS is generally considered the most sensitive imaging modality to evaluate pancreatic lesions but has
several limitations. EUS is highly operator-dependent and limited to qualitative assessment of pancreatic tissue
based on B-mode features. There is an unmet clinical need for a more robust approach to EUS-based
characterization of normal and abnormal pancreatic tissue. In this study, we will develop a system and
methodology for multiparametric endoscopic ultrasound (mpEUS) imaging of pancreatic tissue using B-mode,
ultrasensitive microvessel imaging (UMI), shear-wave elastography (SWE), and tissue microstructure
characterization with pulse-echo quantitative ultrasound (PEQUS). We will implement real-time mpEUS in
HRIs enrolled in our institution’s pancreatic screening program to determine the feasibility and benefits of
mpEUS in a clinical setting. As a secondary objective, we will test the system in a clinical study with 30 PDAC
patients to identify associations with current clinical assessments and mpEUS. We hypothesize that mpEUS
will be sensitive to pathophysiological and microstructural characteristics of pancreatic cancer and its precursor
lesions. There is increasing awareness of the benefits of pancreatic screening and surveillance in HRIs, and
considerable effort has gone into identifying the target population, developing novel biomarkers, and improving
imaging techniques. Multiparametric endoscopic ultrasound offers a non-subjective, quantitative approach for
detection and characterization of pancreatic cancer. Ultimately, this approach could lead to mpEUS imaging
biomarkers that clinicians could use for enhanced pancreatic cancer screening. It is expected that this research
could introduce a safe, cost-effective imaging platform to improve outcomes and save lives of individuals at
high-risk for developing pancreatic cancer.

Grant Number: 5R21CA296688-02
NIH Institute/Center: NIH
Principal Investigator: Mark Burgess