Familial Cancer

, Volume 9, Issue 4, pp 555–561

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

  • Eu Jin Lim
  • Christopher Leung
  • Alex Pitman
  • Damien L. Stella
  • Gregor Brown
  • Masha Slattery
  • Kaye Marion
  • Finlay Macrae
Article

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 syndrome Magnetic resonance colonography Colonoscopy Colorectal 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

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Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Eu Jin Lim
    • 1
  • Christopher Leung
    • 1
  • Alex Pitman
    • 2
  • Damien L. Stella
    • 3
  • Gregor Brown
    • 1
  • Masha Slattery
    • 1
  • Kaye Marion
    • 4
  • Finlay Macrae
    • 1
  1. 1.Department of Gastroenterology and Clinical Nutrition ServiceRoyal Melbourne HospitalParkvilleAustralia
  2. 2.Department of RadiologySt. Vincent’s Hospital MelbourneFitzroyAustralia
  3. 3.Department of RadiologyRoyal Melbourne HospitalParkvilleAustralia
  4. 4.School of Mathematical and Geospatial SciencesRoyal Melbourne Institute of TechnologyMelbourneAustralia

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