The study led by Elizabeth Abou Diwan and colleagues at the Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins School of Medicine, sheds light on the clinical implications of mild MPD dilation in asymptomatic high-risk individuals (HRIs). While MPD dilation has been recognized as a potential early marker of an obstructing pancreatic mass, its significance in individuals undergoing routine pancreatic surveillance has remained unclear.
The researchers aimed to determine the prevalence of ductal dilation in this population and assess its relationship with neoplastic progression, including high-grade dysplasia and pancreatic ductal adenocarcinoma (PDAC).
The study analyzed data from 641 HRIs enrolled in the Cancer of the Pancreas Screening cohort studies, followed for a median of 3.6 years. MPD dilation was defined as a diameter of ≥4 mm in the pancreatic head, ≥3 mm in the body, and ≥2 mm in the tail. The team used Cox regression and time-varying covariate analysis to evaluate the risk of neoplastic progression and applied Kaplan–Meier methods to estimate time-to-progression from both baseline endoscopic ultrasound and baseline duct dilation.
The study revealed the following findings:
- 97 participants (15%) showed main pancreatic duct (MPD) dilation without any detectable obstructing mass.
- Among these, 10 individuals (10.3%) developed neoplastic progression within a median of two years after initial detection.
- HRIs with baseline MPD dilation had a cumulative probability of high-grade dysplasia or pancreatic ductal adenocarcinoma of 16% at five years and 26% at ten years.
- The presence of any ductal dilation increased the risk of progression 2.6 times.
- Risk was particularly high in patients with three or more pancreatic cysts, with an adjusted hazard ratio of 9.07.
The study concludes that even minimal MPD dilation, in the absence of an apparent obstructing lesion, serves as an independent risk factor for neoplastic progression in high-risk individuals. Researchers suggest that HRIs with isolated ductal dilation should undergo shorter surveillance intervals, particularly when multiple pancreatic cysts are present.
The authors acknowledge certain limitations, including the single-center design and the relatively small number of patients who developed neoplastic progression—a common challenge in studies of high-risk pancreatic populations. However, the findings highlight the importance of careful monitoring of MPD changes, even when no mass lesion is evident, for early detection and intervention in pancreatic cancer.
Reference:
Diwan EA, Saba H, Blackford AL, Dbouk M, Chu L, He J, Burkhart R, Hruban RH, Goggins M, Canto MI. Mild Dilatation of the Main Pancreatic Duct Is a Risk Factor for Progression to Pancreatic Cancer in High-Risk Individuals. Gastro Hep Adv. 2025 Sep 12;4(10):100802. doi: 10.1016/j.gastha.2025.100802. PMID: 41142531; PMCID: PMC12547912.
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