Role of endoscopic ultrasonography or magnetic resonance imaging for screening of pancreatic cancer in low-risk individuals

BACKGROUND Magnetic resonance imaging (MRI) and endoscopic ultrasonography (EUS) are recommended in combination for screening pancreatic cancer in high-risk individuals. However, in clinical practice, MRI and EUS are increasingly utilized for pancreatic surveillance during routine health examinations. AIM To investigate the feasibility of these imaging modalities for screening in low-risk individuals. METHODS This retrospective study included patients at low risk for pancreatic cancer who underwent MRI or EUS at two health evaluation centers between March 2019 and December 2024. Basic characteristics, laboratory data, and imaging results were collected. RESULTS A total of 3364 low-risk individuals underwent pancreatic screening: 1553 (46.1%) received MRI, and 1811 underwent EUS. No significant differences were observed in age or sex distribution between the groups. In imaging screening, EUS demonstrated a higher detection rate of abnormal pancreatic lesions (12.8% vs 2.6%; P < 0.001). MRI detected more cystic lesions than did EUS (P < 0.001). EUS identified smaller nodular lesions compared to MRI (9.2 mm vs 18.0 mm; P = 0.044). The MRI group had a higher number of confirmed intraductal papillary mucinous neoplasms (P = 0.031), whereas the EUS group identified more suspected branch-duct intraductal papillary mucinous neoplasms (P < 0.001). Pancreatic adenocarcinoma was found in three patients (0.08%), with no significant difference in detection rates between EUS and MRI (0.11% vs 0.06%; P = 0.656). CONCLUSION In low-risk individuals, MRI and EUS offer comparable effectiveness for pancreatic cancer surveillance. The choice of imaging strategy for health evaluation depends on cost considerations and degree of invasiveness.