MRI-only screening of those at risk of pancreatic cancer shows promise

A new study from the Karolinska Institute in Stockholm, Sweden, demonstrated that a noninvasive screening protocol of MRI alone in individuals at high risk of pancreatic cancer resulted in a lesion yield of 40% in the screened patients.

Marco Del Chiaro, M.D., Ph.D. and colleagues screened 40 at-risk patients over the course of just more than three years, and detailed their findings in JAMA Surgery. Inclusion criteria were individuals with two affected first-degree relatives; patients with Peutz-Jeghers syndrome; and p16, BRCA2 or BRCA1 mutation carriers; and verified germline carriers of a PJS kindred.

The study focused on patients with a five-fold increased risk of getting pancreatic cancer, while most screening programs require a person to have a ten-fold increased risk of contracting the disease. Existing screening programs use include, alone or in combination, MRI, endoscopic ultrasonography (EUS), CT, and endoscopic retrograde cholangiopancreatography, with yeilds of 1.3% to 50%. MRI combined with EUS is considered to be the gold standard.

All patients underwent MRI/magnetic resonance cholangiopancreatography with secretin. Patients for whom no lesions were detected were rescreened in a year; those with abnormalities underwent endoscopic ultrasonography with or without fine-needle aspiration and/or CT.

Of those 40 patients, pancreatic lesions were found in 40% (16) and surgery was ultimately required for 12.5% (5).

Del Chiaro said his findings show the usefulness of MRI-based protocol for detecting cancer or premalignant lesions in at-risk individuals.

“The study confirms our hypothesis that MRI is a useful imaging modality for the surveillance of individuals at risk for pancreatic cancer,” Del Chiaro wrote in an email to RadiologyBusiness.com. “In particular, in familial pancreatic cancer patients, where most of the findings are cystic lesions ... the MRI can probably be considered the gold standard.”

However, Del Chiaro et al acknowledged in their report that the small number of patients and the divergent results did not allow evaluation of the efficacy of MRI as a single screening modality. The current gold standard is considered to be MRI and endoscopic ultrasonography.

In an accompanying editorial, Mark S. Talamonti, M.D., of the NorthShore University HealthSystem in Evanston, Ill., agreed that the results are promising for a disease for which there currently exist no biomarkers for early detection, but more research is needed before MRI is validated. “The small number of total patients and short follow-up of the nonsurgical patients preclude any definitive recommendations for MRI as the single screening modality of choice,” he said in a commentary for JAMA Surgery.

He also points out that just 10% of pancreatic cancers occur in patients with syndromic risk factors or familial history, and the remaining 90% are considered sporadic cancers. "Population screening with radiographic imaging or endoscopic procedures makes no clinical or economic sense for a cancer that represents only 3% of estimated new cancers each year," he wrote.

Nonetheless, pancretic cancer is the fourth leading cause of death, and aging trends increase the urgency for progress against a "formidable" cancer, Talamonti wrote. "There is a clear and unequivocal need for affordable screening strategies based on reliable biomarkers and efficient imaging modalities,” he concluded.

Del Chiaro told RadiologyBusiness.com via email that there are already plans for follow-up studies to further this research.