Abstract
Lynch syndrome gene carriers have a 50–80% risk of colorectal cancer (CRC). Current guidelines recommend yearly colonoscopy, with associated procedure-related risks. Magnetic resonance colonography (MRC) was evaluated as a non-invasive alternative for CRC screening in this high-risk population. Adult Lynch syndrome gene carriers underwent both screening procedures on the same day. MRI radiologists read the scans and rated image quality. Endoscopists performed colonoscopy unaware of MRC findings until after procedure completion. If lesions were detected, their number, size and location were noted. Post-procedure, patients compared discomfort and inconvenience of MRC and colonoscopy on a visual analogue scale. Thirty patients were recruited. 83% of the MRC scans were of adequate to good quality. MRC detected three lesions in three patients (70, 36, 17 mm). All 3 were independently detected on colonoscopy, excised and found to be CRC. MRC failed to detect a 3 mm CRC found on colonoscopy. CRC prevalence was 13%. Colonoscopy detected a further 30 polyps, all <10 mm. Of these, 17 were hyperplastic polyps and 10 normal mucosa. Colonoscopy had a false positive rate of 32% as defined by histology. MRC failed to detect any polyp <10 mm. Mean patient discomfort scores were 20% for MRC and 68% for colonoscopy, P = 0.003. Mean patient inconvenience scores were 54% for MRC and 52% for colonoscopy, P = 0.931. MRC was reliable in detecting large polyps, potentially CRC. However MRC currently has poor sensitivity in detecting small polyps, limiting its utility in adenoma screening at this time. MRC was associated with less discomfort than CC.
Similar content being viewed by others
Abbreviations
- CRC:
-
Colorectal cancer
- CTC:
-
Computed tomography colonography
- DNA:
-
Deoxyribonucleic acid
- MLH1:
-
Human MutL Homolog-1
- MMR:
-
Mismatch repair
- MRC:
-
Magnetic resonance colonography
- MRI:
-
Magnetic resonance imaging
- MSH2:
-
Human MutS Homolog-2
- MSH6:
-
Human MutS Homolog-6
References
Annie Yu HJ, Lin KM, Ota DM et al (2003) Hereditary non-polyposis colorectal cancer: preventive management. Cancer Treat Rev 29(6):461–470
DeFrancisco J (2003) Diagnosis and management of hereditary non-polyposis colon cancer. Gastrointest Endosc 58(3):390–408
Chung DC, Rustgi AK (2003) The hereditary non-polyposis colorectal cancer syndrome: genetics and clinical implications. Ann Intern Med 138(7):560–570
Lynch HT, De la Chapelle A (2003) Hereditary colorectal cancer. N Engl J Med 348(10):919–932
Järvinen HJ, Aarnio M, Mustonen H et al (2000) Controlled 15-year trial on screening for colorectal cancer in families with hereditary nonpolyposis colorectal cancer. Gastroenterology 118(5):829–834
Purkayastha S, Tekkis PP, Athanasiou T et al (2005) Magnetic resonance colonography versus colonoscopy as a diagnostic investigation for colorectal cancer: a meta-analysis. Clin Radiol 60(9):980–989
Rockey DC, Paulson E, Niedzwiecki D et al (2005) Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison. Lancet 365(9456):305–311
Renkonen-Sinisalo L, Kivisaari A, Kivisaari L et al (2007) Utility of computed tomographic colonography in surveillance for hereditary nonpolyposis colorectal cancer syndrome. Fam Cancer 6(1):135–140
Cotton PB, Durkalski VL, Pineau BC et al (2004) Computed tomographic colonography (virtual colonoscopy) a multicenter comparison with standard colonoscopy for detection of colorectal neoplasia. JAMA 291(14):1713–1719
De Vos Tot Nederveen Cappel WH, Nagengast FM, Griffioen G et al (2002) Surveillance for hereditary nonpolyposis colorectal cancer: a long-term study on 114 families. Dis Colon Rectum 45(12):1588–1594
Viiala CH, Zimmerman M, Cullen DJE et al (2003) Complication rates of colonoscopy in an Australian teaching hospital environment. Intern Med J 33:355–359
Mecklin JP, Jarvinen HJ (2005) Surveillance in Lynch syndrome. Fam Cancer 4(3):267–271
Pappalardo G, Polettini E, Frattaroli FM et al (2000) Magnetic resonance colonography versus conventional colonoscopy for the detection of colonic endoluminal lesions. Gastroenterology 119(2):300–304
Hartmann D, Bassler B, Schilling D et al (2006) Colorectal polyps: detection with dark-lumen MR colonography versus conventional colonoscopy. Radiology 238(1):143–149
Luboldt W, Bauerfeind P, Wildermuth S et al (2000) Colonic masses: detection with MR colonography. Radiology 216(2):383–388
Ajaj W, Pelster G, Treichel U et al (2003) Dark lumen magnetic resonance colonography: comparison with conventional colonoscopy for the detection of colorectal pathology. Gut 52:1738–1743
Yusuf E, Florie J, Nio CY et al. (2009) Incidental extracolonic findings on bright lumen MR colonography in a population at increased risk for colorectal carcinoma. Eur J Radiol Oct 15. Epub ahead of print
Achiam MP, Holst Andersen LP, Klein M et al (2009) Preoperative evaluation of synchronous colorectal cancer using MR colonography. Acad Radiol 16(7):790–797
Kuehle CA, Langhorst J, Ladd SC et al (2007) Magnetic resonance colonography without bowel cleansing: a prospective cross sectional study in a screening population. Gut 56(8):1079–1085
Saar B, Gschossmann JM, Bonel HM et al (2008) Evaluation of magnetic resonance colonography at 3.0 Tesla regarding diagnostic accuracy and image quality. Invest Radiol 43(8):580–586
Lauenstein TC, Saar B, Martin DR (2007) MR colonography: 1.5T versus 3T. Magn Reson Imaging Clin N Am 15(3):395–402
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lim, E.J., Leung, C., Pitman, A. et al. Magnetic resonance colonography for colorectal cancer screening in patients with Lynch syndrome gene mutation. Familial Cancer 9, 555–561 (2010). https://doi.org/10.1007/s10689-010-9350-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10689-010-9350-9