Magnetic resonance imaging surveillance detects early-stage pancreatic cancer in carriers of a p16-Leiden mutation.
OBJECTIVE
Surveillance of high-risk groups for pancreatic cancer might increase early detection and treatment outcomes. Individuals with germline mutations in p16-Leiden have a lifetime risk of 15% to 20% of developing pancreatic cancer. We assessed the feasibility of detecting pancreatic cancer at an early stage and investigated the outcomes of patients with neoplastic lesions.


METHODS
Individuals with germline mutations in p16-Leiden (N = 79; 31 male; mean age, 56 years; range, 39-72 years) were offered annual surveillance by magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP). Those found to have neoplastic lesions were offered options for surgery or intensive follow-up. Individuals found to have possible neoplastic lesions were examined again by MRI/MRCP within 2 to 4 months.


RESULTS
After a median follow-up period of 4 years (range, 0-10 years), pancreatic cancer was diagnosed in 7 patients (9%). The mean age at diagnosis was 59 years (range, 49-72 years). Three of the tumors were present at the first examination, and 4 were detected after a negative result in the initial examination. All 7 patients had a resectable lesion; 5 underwent surgery, 3 had an R0 resection, and 2 had lymph node metastases. Possible precursor lesions (ie, duct ectasias, based on MRCP) were found in 9 individuals (11%).


CONCLUSIONS
MRI/MRCP detects small, solid pancreatic tumors and small duct ectasias. Although surveillance increases the rate of resectability, carriers of a p16-Leiden mutation develop aggressive tumors.
Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands. hfavasen@stoet.nl
Hans F A
HF
Vasen
Martin
M
Wasser
Anneke
A
van Mil
Rob A
RA
Tollenaar
Marja
M
Konstantinovski
Nelleke A
NA
Gruis
Wilma
W
Bergman
Frederik J
FJ
Hes
Daniel W
DW
Hommes
G Johan A
GJ
Offerhaus
Hans
H
Morreau
Bert A
BA
Bonsing
Wouter H
WH
de Vos tot Nederveen Cappel
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D049448:Cholangiopancreatography, Magnetic Resonance; D055088:Early Detection of Cancer; D005240:Feasibility Studies; D005260:Female; D019942:Genes, p16; D020022:Genetic Predisposition to Disease; D018095:Germ-Line Mutation; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands; D010179:Pancreas / Q000473:pathology* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000601:surgery; D010641:Phenotype; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries; D013997:Time Factors