Abstract PR-9: Results of surveillance for hereditary pancreatic cancer using MRI(CP)

Surveillance for pancreatic cancer (PC) in high risk groups may lead to early detection and may improve overall survival. We screened for early pancreatic neoplasia in individuals with a p16- germline mutation or with a strong family history of PC (FPC).

Since 2000, high risk individuals were offered annual surveillance by Magnetic Resonance Imaging (MRI(CP)). In case of suspected lesions, surgery or additional follow up (FU) was provided. In case of doubt, the examination was repeated within 2-4 months.

A total of 66 (28 M) individuals with an average age of 56 yrs (range: 40-72) were studied (60 from p16, six from FPC families). The median FU was 3.4 yrs (range: 0-7). In 20% of the patients, a (pre)malignant lesion was detected. Ductectasias or IPMN (intraductal papillary mucinous neoplasm) were identified in eight patients (12%). Three patients underwent a prophylactic partial resection of the pancreas; histology showed IPMN in one and PanIn-II lesions in two patients. Five patients (8%) were diagnosed with PC. Three asymptomatic patients underwent partial pancreatectomy. One patient had no evidence for residual disease after surgery. The second patient had positive resection margins and nodes but survived 21 months. The third patient had metastatic carcinoid at surgery (in addition to pancreatic cancer). The remaining two patients did not undergo surgery because of metastatic disease (pulmonary metastases of melanoma, metastatic pancreatic cancer).

(Pre)malignant lesions were identified in a high proportion of patients. Small lesions of a few mm can be detected by MRI(CP). In view of the substantial morbidity of pancreatic surgery, a major challenge is to decide at what stage and to what extent prophylactic surgery should be performed. Close observation of high risk groups provides valuable information on the natural history of neoplastic lesions in the pancreas.

Citation Information: Cancer Prev Res 2008;1(7 Suppl):PR-9.