MRI Screening ‘Effective’ for Individuals at High Risk of Pancreatic Cancer

Pancreatic cancer screening may be feasible in patients known to have genetic or syndromal predisposition for the disease

medwireNews: Patients at high risk of developing pancreatic cancer may benefit from an annual magnetic resonance imaging (MRI) screening programme, suggests research published in JAMA Surgery.

The screening study included 24 women and 16 men, aged an average of 49.9 years, with multiple family members affected by either pancreatic ductal adenocarcinoma (PDAC), or a BRCA1, BRCA2 or p16 mutation and at least one family member with PDAC, or a family member with Peutz–Jeghers syndrome.

In all, 40% of the 40 patients who underwent the non-invasive protocol had positive findings, including 14 cases of suspected intraductal papillary mucinous neoplasia (IPMN) and two cases of pancreatic ductal carcinoma. One patient had both types of disease.

The screening results led to immediate surgery in two patients with non-invasive IPMN. A third patient had an IPMN in the pancreatic tail monitored at 6-month intervals until a solid lesion was identified in the pancreatic head. Histology on resection confirmed the presence of IPMN in the tail region and PDAC in the head.

Two other patients underwent surgery for PDAC, one of whom had early-stage disease. However, the second patient, who had missed the second year’s screening, developed abdominal pain and was diagnosed with advanced cancer in the pancreatic head.

The remaining patients with MRI findings continued to undergo screening at 6-month intervals, 63.6% of whom had stable findings after a median of 9.4 months, while 36.4% had limited non-significant disease progression over a median of 19.0 months.

 

Marco Del Chiaro, from the Karolinska Institute in Stockholm, Sweden, and co-authors say that the protocol appears to have “good accuracy” for identifying cancer and premalignant lesions.

Nevertheless, they caution that just three of the five surgeries were prophylactic or treated early cancer, and two of these procedures were on non-invasive IPMN lesions with an unknown benefit to the patient.

“One principal obstacle to effective surveillance, encountered in the current study as in previous studies, is the lack of knowledge about the natural history of premalignant lesions of the pancreas, as well as the lack of criteria for reliable prediction of progression and outcome of these lesions in individual high-risk patients”, the authors observe.

Mark Talamonti, from NorthShore University HealthSystem in Evanston, Illinois, USA, says in an accompanying comment that while the study demonstrates the ability to detect lesions in high-risk patients, just 10% of pancreatic cancers occur in individuals with a family history of pancreatic cancer or a related syndrome.

Writing that the “real challenge” is the early detection of pancreatic cancer in the 90% of patients who have sporadic disease with no known biomarkers, he concludes: “There is a clear and unequivocal need for affordable screening strategies based on reliable biomarkers and efficient imaging modalities.”

References

Del Chiaro M, Verbeke CS, Kartalis N, et al. Short-term results of a magnetic resonance imaging-based Swedish screening program for individuals at risk for pancreatic cancer. JAMA Surg 2015; Advance online publication 8 April. doi:10.1001/jamasurg.2014.3852

Talamonti M. Screening strategies for pancreatic cancer in high-risk patients. Opportunities to make a real impact but many questions and challenges still ahead.JAMA Surg 2015; Advance online publication 8 April. doi:10.1001/jamasurg.2015.0391

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