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(2005), 'Ductal neoplasia of the pancreas: nosologic, clinicopathologic, and biologic aspects', Semin Radiat Oncol (15; United States), 254-64. Lowenfels, A. B. and Maisonneuve, P. (2006), 'Epidemiology and risk factors for pancreatic cancer', Best Pract Res Clin Gastroenterol (20; England), 197-209. Canto, M. I., et al. (2004), 'Screening for pancreatic neoplasia in high-risk individuals: an EUS-based approach', Clin Gastroenterol Hepatol (2; United States), 606-21. Reddy, R. P., et al. (2004), 'Pancreatic mucinous cystic neoplasm defined by ovarian stroma: demographics, clinical features, and prevalence of cancer', Clin Gastroenterol Hepatol (2; United States), 1026-31. Canto, M. I., et al. (2006), 'Screening for early pancreatic neoplasia in high-risk individuals: a prospective controlled study', Clin Gastroenterol Hepatol (4; United States), 766-81; quiz 665. 2015-05-28 Malignant neoplasms are by now the second largest group of causes of death. Pancreatic cancer is among the top ten most common types of cancer. The 5- year survival rate is below 5%. There are different ways of classifying neoplasms of the pancreas. Adenocarcinomas account for the largest share (85%) of all pancreatic neoplasms. Other entities include serous cystadenomas, intraductal papillary mucinous neoplasms, mucinous cystic neoplasms and pseudocysts, which are the most common cystic lesion. The familial pancreatic cancer is rare and occurs most frequently as pancreatic carcinoma syndrome. Several registers record patients with familial pancreatic cancer (NFPTR in Baltimore, EUROPAC in Liverpool, FaPaCa in Marburg). There are various screening programs for affected families and there is no consensus about the algorithm of screening those patients yet. In this study, the prevalence of cystic lesions of the pancreas in high risk individuals compared to a normal population was investigated. Furthermore, it was to be studied how those lesions present, if the lesions change over time and to what degree the interobserver agreement presents. For this purpose, an analysis sheet was created. Via this sheet images of MRI and MRCP were evaluated. Two groups of patients were studied. The first group was recruited from the screening program for high risk individuals of the FaPaCa register Marburg. The images of these patients were evaluated by two examiners. The second group consisted of patients who had an MRI of the upper abdomen in 2009/2010. These pictures were examined by one observer. This group was subdivided into patients with and without pancreatic pathology based on the indication for the MRI. There were cystic lesions to be found in 43.1% of high risk individuals, 18.3% of patients without pancreatic pathology and 42.7% of patients with pancreatic pathology. 41.8% of the lesions in the high risk individuals had contact with the main pancreatic duct, respectively 72.2% in the group of patients with pancreatic pathology and 50% in the group without pancreatic pathology. Multilocular cysts made up 17.2% of cysts in the group of high risk individuals, 58.3% of lesions in the group of patients with pancreatic pathology and 21.4% in the group of patients without pancreatic pathology. The evaluation of follow-up studies showed that in 57.4% there was no change. The interobserver agreement in the analysis of high risk individuals was very good. The prevalence of asymptomatic cysts in this study and in other studies is comparable. The challenge is for one the transferability of the finding to the general population and secondly the question of how to deal with such incidental findings. In the absence of malignant predictors, a conservative management strategy is often recommended. High-risk patients frequently show cystic lesions, simple cysts as well as multilocular cystic lesions such as IPMN. Further studies with follow-ups over a longer period of time are needed to gain clarity in the management of those lesions. Zystische Veränderungen des Pankreas in der Diagnose des Pankreaskarzinoms: Vergleich einer Hochrisikogruppe mit einem Normalkollektiv Klinik für Strahlentherapie monograph urn:nbn:de:hebis:04-z2015-02658 ths Prof. Dr. Dr. Heverhagen Johannes Heverhagen, Johannes (Prof. Dr. Dr.) Bauchspeicheldrüsenkrebs Medizin doctoralThesis German Philipps-Universität Marburg ppn:359524788 pankreas karzinom Cystic lesions of the pancreas in diagnosing pancreatic cancer: a comparison of high risk individuals to a normal population https://doi.org/10.17192/z2015.0265 Medical sciences Medicine Medizin cystic lesion Bösartige Neubildungen sind mittlerweile die zweitgrößte Gruppe der Todesursachen. Das Pankreaskarzinom gehört zu den zehn häufigsten Krebsarten. Die 5-Jahres-Überlebensrate liegt unter 5%. Neubildungen des Pankreas lassen sich auf unterschiedliche Art und Weise unterteilen, wobei die Adenokarzinome mit 85% den größten Anteil ausmachen. Weitere Entitäten sind seröse Zystadenome, intraduktale papillär-muzinöse Neoplasien, muzinös-zystische Neoplasien und Pseudozysten, welche die häufigsten zystischen Läsionen darstellen. Das familiäre Pankreaskarzinom ist insgesamt selten und kommt am häufigsten als Pankreaskarzinomsyndrom vor. Verschiedene Register erfassen Patienten mit familiärem Pankreaskarzinom (NFPTR in Baltimore, EUROPAC in Liverpool, FaPaCa in Marburg). Es existieren verschiedene Screeningprogramme für betroffene Familien, wobei über den Algorithmus noch kein Konsens besteht. In dieser Arbeit wurde die Prävalenz zystischer Läsionen des Pankreas bei Hochrisikopatienten im Vergleich zu einer Normalpopulation untersucht. Des Weiteren sollten Aussagen dazu gemacht werden, wie sich diese Läsionen präsentieren, wie sich die Läsionen im Laufe der Zeit verändern und ob eine Untersucherabhängigkeit nachzuweisen ist. Dazu wurde ein Auswertungsbogen erstellt, mit Hilfe dessen die Bilder einer MR-Bildgebung und MRCP befundet wurden. Dabei wurden zwei Patientenkollektive untersucht. Die erste Gruppe wurde aus dem Screeningprogramm für Hochrisikopatienten des FaPaCa-Registers Marburg rekrutiert. Die Bilder dieser Patienten wurden von zwei Untersuchern befundet. Die zweite Gruppe bestand aus Patienten, bei welchen 2009/2010 eine MR-Bildgebung des Oberbauchs durchgeführt wurde, diese wurden von einem Untersucher befundet. Diese Gruppe wurde anhand der Indikation für die Untersuchung noch unterteilt in Patienten mit und ohne Pankreaspathologie. Es zeigten sich zystische Läsionen bei 43,1% der Hochrisikopatienten, bei 18,3% der Patienten ohne Pankreaspathologie und 42,7% der Patienten mit Pankreaspathologie. Kontakt mit dem Pankreashauptgang hatten 41,8% der Läsionen bei den Hochrisikopatienten, 72,2% in der Gruppe der Patienten mit Pankreaspathologie und 50% in der Gruppe ohne Pankreaspathologie. Multilokuläre Zysten machten bei den Hochrisikopatienten 17,2% der Läsionen aus, bei Patienten mit Pankreaspathologie 58,3% und bei Patienten ohne Pankreaspathologie 21,4%. Bei der Auswertung von Folgeuntersuchungen zeigte sich, dass 57,4% keine Veränderung aufwiesen. Die Übereinstimmung zwischen den Untersuchern in der Auswertung der Hochrisikopatienten war sehr gut. Die Prävalenz asymptomatischer Zysten in dieser Arbeit und in anderen Untersuchungen ist vergleichbar. Problematisch ist die Übertragbarkeit auf die Normalbevölkerung und die Frage nach dem Umgang mit solchen Zufallsbefunden, wobei bei Fehlen von Malignitätsprädiktoren mehrheitlich eine konservative Beobachtungsstrategie empfohlen wird. Hochrisikopatienten zeigen häufig zystische Läsionen und dabei sowohl einfach Zysten als auch multilokuläre wie zum Beispiel IPMN. Weitere Studien mit engmaschigeren Verlaufskontrollen über einen längeren Zeitraum sind nötig, um sich über das Management dieser Läsionen Klarheit zu verschaffen. application/pdf Publikationsserver der Universitätsbibliothek Marburg Universitätsbibliothek Marburg 2015 2015-02-24 pancreas opus:6087 Biel, Esther Biel Esther