Pancreatic Duct Dilation: A Sentinel Biomarker for Early Intervention

Johns Hopkins investigators have shown that mild main pancreatic duct dilation identifies higher pancreatic cancer risk in high‑risk surveillance cohorts.

In a long‑running prospective screening cohort, 641 high‑risk individuals underwent routine MRI and endoscopic ultrasound surveillance; 97 participants had duct enlargement without an obstructing mass, and 10 went on to develop high‑grade dysplasia or pancreatic cancer at a median interval of about two years.

There was an approximate 2.6‑fold relative likelihood of progression among those with baseline duct widening and cumulative probabilities of roughly 16% at five years and 26% at ten years, with a stronger signal in participants who had more than three pancreatic cysts.

Those quantified risks translate into concrete surveillance decisions. In absolute terms, a 16% five‑year and 26% ten‑year cumulative probability implies meaningful near‑term risk that can justify intensified follow‑up; in relative terms, an ~2.5–3‑fold increase supports earlier escalation in selected patients.