Familial Cancer

, Volume 9, Issue 4, pp 555–561

Magnetic resonance colonography for colorectal cancer screening in patients with Lynch syndrome gene mutation

Authors

    • Department of Gastroenterology and Clinical Nutrition ServiceRoyal Melbourne Hospital
  • Christopher Leung
    • Department of Gastroenterology and Clinical Nutrition ServiceRoyal Melbourne Hospital
  • Alex Pitman
    • Department of RadiologySt. Vincent’s Hospital Melbourne
  • Damien L. Stella
    • Department of RadiologyRoyal Melbourne Hospital
  • Gregor Brown
    • Department of Gastroenterology and Clinical Nutrition ServiceRoyal Melbourne Hospital
  • Masha Slattery
    • Department of Gastroenterology and Clinical Nutrition ServiceRoyal Melbourne Hospital
  • Kaye Marion
    • School of Mathematical and Geospatial SciencesRoyal Melbourne Institute of Technology
  • Finlay Macrae
    • Department of Gastroenterology and Clinical Nutrition ServiceRoyal Melbourne Hospital
Article

DOI: 10.1007/s10689-010-9350-9

Cite this article as:
Lim, E.J., Leung, C., Pitman, A. et al. Familial Cancer (2010) 9: 555. doi:10.1007/s10689-010-9350-9

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.

Keywords

Lynch syndromeMagnetic resonance colonographyColonoscopyColorectal cancer screening

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

Copyright information

© Springer Science+Business Media B.V. 2010