Development of a high risk pancreatic screening clinic using 3.0 T MRI

• Published in: Familial cancer Vol. 17; no. 1; pp. 101 - 111
• Main Authors: Barnes, Chad A., Krzywda, Elizabeth, Lahiff, Shannon, McDowell, Dena, Christians, Kathleen K., Knechtges, Paul, Tolat, Parag, Hohenwalter, Mark, Dua, Kulwinder, Khan, Abdul H., Evans, Douglas B., Geurts, Jennifer, Tsai, Susan
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 2018; Springer Nature B.V
• Subjects: Adult; Aged; Biomedical and Life Sciences; Biomedicine; BRCA1 protein; BRCA2 protein; Cancer Research; Cholangiocarcinoma; Early Detection of Cancer - methods; Early Detection of Cancer - standards; Endosonography; Epidemiology; Feasibility Studies; Female; Genetic Counseling; Genetic Predisposition to Disease; Genetic Testing; Human Genetics; Humans; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical screening; Middle Aged; Neoplastic Syndromes, Hereditary - diagnostic imaging; Neoplastic Syndromes, Hereditary - genetics; Original Article; Pancreas - diagnostic imaging; Pancreatic cancer; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - genetics; Patient Care Team; Patients; Practice Guidelines as Topic; Risk Assessment - methods; Surgery; Surveillance; Ultrasound; High risk; Familial pancreatic cancer; Pancreas cancer screening
• ISSN: 1389-9600; 1573-7292
• DOI: 10.1007/s10689-017-0057-z

Selective screening for pancreatic cancer (PC) has been proposed. We describe the establishment of a comprehensive multidisciplinary screening program using 3.0 T MRI. Criteria for screening included the presence of PC in: ≥ 2 first degree relatives (FDR), 1 FDR and 1 s degree relative (SDR), ≥ 3 any degree relatives (ADR), or any known hereditary cancer syndrome with increased PC risk. Imaging with 3.0 T MRI was performed routinely and endoscopic ultrasound was used selectively. Screening was completed in 75 patients (pts). Hereditary cancer syndromes were present in 42 (56%) of the 75 pts: BRCA2 (18), ATM (8), BRCA1 (6), CDKN2A (4), PALB2 (3), Lynch (2), and Peutz-Jeghers (1). A family history of PC was present in ≥ 2 FDR in 12 (16%) pts, 1 FDR and 1 SDR in 5 (7) pts, and ≥ 3 ADR in 16 (21%) pts. Of the 65 pts who received screening MRI, 28 (43%) pts had pancreatic cystic lesions identified, including 1 (1%) patient in whom a cholangiocarcinoma was diagnosed as well. No patient underwent surgical resection. Using a 3.0 T MRI to screen patients at high risk for developing PC identified radiographic abnormalities in 43% of patients, which were stable on subsequent surveillance. Specific guidelines for the frequency of surveillance and indications for surgery remain areas of active investigation as the global experience with high risk screening continues to mature.