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.