Clinical impact of K-ras mutation analysis in EUS-guided FNA specimens from pancreatic masses

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• 作者：Takeshi Ogura ; MD¹ ; ⁵ ; Kenji Yamao ; MD¹ ; ; Akira Sawaki ; MD¹ ; Nobumasa Mizuno ; MD¹ ; Kazuo Hara ; MD¹ ; Susumu Hijioka ; MD¹ ; Yasumasa Niwa ; MD¹ ; Masahiro Tajika ; MD¹ ; Shinya Kondo ; MD¹ ; Yasuhiro Shimizu ; MD² ; Vikram Bhatia ; MD⁴ ; Kazuhide Higuchi ; MD⁵ ; Waki Hosoda ; MD³ ; Yasushi Yatabe ; MD³
• 关键词：AIP ; autoimmune pancreatitis ; CP ; chronic pancreatitis ; EUS-FNA ; EUS-guided FNA ; NPV ; negative predictive value ; PanIN ; pancreatic intraepithelial neoplasia ; PCR ; polymerase chain reaction ; PDAC ; pancreatic ductal adenocarcinoma ; PNET ; pancreatic neuroend
• 刊名：Gastrointestinal Endoscopy
• 出版年：2012
• 出版时间：April, 2012
• 年：2012
• 卷：75
• 期：4
• 页码：769-774
• 全文大小：417 K

文摘

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Background

EUS-guided FNA (EUS-FNA) is considered optimal for differentially diagnosing pancreatic masses. However, the sensitivity of EUS-FNA ranges from 65 % to 95 % , respectively, which requires improvement.

Objective

To evaluate clinical impact of K-ras mutation analysis in EUS-FNA specimens from pancreatic masses.

Design

Prospective registration, single-center study.

Setting

Tertiary referral center.

Patients

This study involved 394 consecutive patients with pancreatic masses (307 pancreatic ductal adenocarcinomas [PDACs], 47 pancreatic inflammatory lesions, and 40 other types of tumors) who underwent EUS-FNA and analysis of K-ras mutations.

Intervention

EUS-FNA, Cycleave polymerase chain reaction.

Main Outcome Measurements

Improvement of the diagnostic accuracy by K-ras mutation analysis; absence of K-ras mutations in non-PDAC masses.

Results

K-ras mutations were detected in 266 of 307 PDAC aspirates (87 % ) and in 3 of 87 non-PDAC masses (3 % ). K-ras mutations were detected in 18 of 39 patients (46 % ) who remained cytohistopathologically undiagnosed. The sensitivity, specificity, positive and negative predictive values, and accuracy of cytohistopathological and K-ras mutation analyses alone were 87 % , 100 % , 100 % , 54 % , and 89 % , respectively, and, when combined, were 93 % , 100 % , 100 % , 68 % , and 94 % , respectively. Adding K-ras mutation analysis to standard cytohistopathological assessment increased the sensitivity and accuracy of EUS-FNA by 6 % (P < .001) and 5 % (P < .001), respectively.

Limitations

Single-center study.

Conclusions

K-ras mutation analysis may be helpful in patients with suspected PDAC yet inconclusive EUS-FNA findings. K-ras mutations were extremely rare in pancreatic inflammation and other pancreatic tumors.