In patients with pancreatic cancer, at diagnosis approximately 40-45% have metastatic disease and 40% have a locally advanced tumor with involvement of surrounding vessels or organs. Only 5-25% of all patients are potentially eligible for surgery, the only potential cure. During surgery, approximately 10-20% of the patients are considered unresectable because of unexpected liver metastases, peritoneal carcinomatosis or locally advanced disease. Furthermore, in 24-53% of the patients there is recurrence in the liver after surgery, of which 50% within 6 months, suggesting these liver metastases were already present at the time of surgery. These liver metastases are too small to be detected by routine preoperative ultrasound and contrast-enhanced CT (CETC).
With contrast-enhanced, diffusion-weighted MRI (CE-DW-MRI) we can possibly improve detection of liver metastases, improving staging of pancreatic cancer. Therefore a clinical trial on CE-DW-MRI to detect liver metastases in patients with pancreatic cancer is currently ongoing (the DIA-PANC study). As most of these lesions are not visible on transabdominal ultrasound, it is often not possible to obtain a histopathologic biopsy in in order to prove the presence of liver metastases. Therefore, we want to perform MR-guided liver biopsy in these patients, as the next minimal invasive step, to obtain histopathologic proof of liver metastases.
Currently, a pilot feasibility study (META-PANC study, n=20) is ongoing, in which we perform MR-guided liver biopsies under local anaesthesia at the Medical Innovation and Technology Expert Center (MITeC) in patients with liver lesions, visible only on MRI, not on CECT or abdominal ultrasound.