Prevalence and Clinical Impact of Extra-pancreatic Incidental Findings Noted on Magnetic Resonance Imaging and Endoscopic Ultrasound Performed for Pancreatic Cancer Screening

BACKGROUND AND AIMS: Incidental findings on pancreatic cancer screening tests can influence costs and patient preferences. We sought to determine the prevalence and clinical impact of extra-pancreatic inci-dentally findings noted on screening magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS). METHODS: We identified 200 consecutive patients who underwent MRI (n = 100) and EUS (n = 100) for pancreatic cancer screening at our institution from 2015 to 2020. Extra-pancreatic incidental findings on MRI and EUS were recorded. Medical records were searched to determine follow-up and final diag-nosis for incidental findings. Incidental findings were categorized as potentially serious or not serious. RESULTS: During the study period, 180 consecutive patients who underwent MRI (n = 90) and EUS (n = 90) for pancreatic cancer screening met inclusion criteria. The average age of study subjects was 62 years, and were mostly female (67%), and white (84.4%). The most common indication for screening was BRCA 1 of 2 pathogenic variant (60%). Overall, incidental findings were noted in 52.2% patients undergoing screening and a diagnosis of extra-pancreatic malignancy was made in 2.2% patients. Inci-dental findings were noted in 84.4% patients undergoing MRI compared with 20% undergoing EUS (RR=4.9; P < 0.001). Potentially serious incidental findings were noted in 16.7% patients undergoing MRI compared with 6.7% undergoing EUS (P = 0.005). Patients undergoing MRI were 1.7-times more likely than those undergoing EUS to require invasive testing or follow-up (P = 0.057). CONCLUSION: An almost 5-fold difference in prevalence of incidental findings was noted between patients undergoing MRI and EUS for pancreatic cancer screening. This should be discussed with patients when counseling them on choosing between these modalities.