HE LYNCH SYNDROME (IE, hereditary nonpolyposis colorectal cancer [HNPCC]) is the most common familial colorectal cancer (CRC). 1,2It can be caused by germline deleterious mutations of DNA mismatch repair (MMR) genes, including MLH1, 3,4 MSH2, 5 MSH6, 6 and several others. 7Screening for individuals likely to carry a deleterious mutation of these genes has traditionally relied on examination of family history, as per the Amsterdam Criteria, 8-10 and has recently moved toward multistep algorithms combining family history with molecular tumor characteristics such as micro-satellite instability (MSI), 11 as per the Bethesda Guidelines. 2,12he latter were developed to help recognize those individuals who would potentially benefit from a more detailed mo-lecular diagnostic workup, including MSI and subsequent germline testing.This approach is useful, but not without important limitations.First, MSI tests can only be performed on affected patients See also