Endoscopic Ultrasound-guided Fine-Needle Aspiration Biopsy Coupled With a KRAS Mutation Assay Using Allelic Discrimination Improves the Diagnosis of Pancreatic Cancer

被引:49
作者
Bournet, Barbara [1 ,2 ]
Selves, Janick [2 ,3 ]
Grand, David [3 ]
Danjoux, Marie [3 ]
Hanoun, Naima [2 ]
Cordelier, Pierre [2 ]
Buscail, Louis [1 ,2 ]
机构
[1] Univ Toulouse, Dept Gastroenterol, F-31059 Toulouse 9, France
[2] Univ Toulouse, CHU Toulouse Rangueil, INSERM, UMR 1037, F-31059 Toulouse 9, France
[3] Univ Toulouse, CHU Toulouse Purpan, Dept Pathol, F-31059 Toulouse 9, France
关键词
pancreatic ductal adenocarcinoma; endoscopic ultrasound-guided fine-needle aspiration; solid pancreatic mass; KRAS-mutation assay; qPCR analysis; K-RAS; EUS-FNA; MASSES; YIELD; SAMPLES; TUMOR;
D O I
10.1097/MCG.0000000000000053
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Goals and Background: Mutation of the KRAS oncogene is present in 75% to 95% of pancreatic cancer tissues. This study aimed to evaluate whether endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), combined with analysis of the KRAS mutation, improves the diagnosis of pancreatic cancer in cases of inconclusive or doubtful cytopathologic analysis. Patients and Methods: We prospectively included 186 patients with a pancreatic mass (103 men; mean age: 62 y). Cytopathology and KRAS mutations, using TaqMan MGB allelic discrimination, were performed on EUS-FNA material. A final diagnosis was obtained from EUS-FNA analysis and/or a subsequent biopsy if necessary, and/or surgery, and follow-up: these were pancreatic adenocarcinoma (n = 104), other malignant pancreatic tumors (n = 22), and benign lesions (n = 60, including 35 cases of chronic pancreatitis). Results: Inconclusive or doubtful (low-grade dysplasia or atypia) cytopathology was found in 68 cases. Of these, 29 patients who had adenocarcinoma were subsequently diagnosed, including 19 cases with a former KRAS mutation. Sensitivity, specificity, positive and negative predictive values, and overall accuracy of cytopathology alone to diagnose adenocarcinoma were 73%, 100%, 100%, 75%, and 85%, respectively. When KRAS mutation analysis was combined with pathology, these values reached 88%, 99%, 99%, 89%, and 93%, respectively. The performance of EUS-FNA to diagnose malignancy was similarly improved after the KRAS-mutation assay (negative predictive value increased from 67% to 88%; accuracy increased from 85% to 94%). Conclusions: EUS-FNA plus KRAS-mutation analysis, using allelic discrimination, is accurate and improves the diagnosis of pancreatic adenocarcinoma when pathology is inconclusive or doubtful.
引用
收藏
页码:50 / 56
页数:7
相关论文
共 21 条
[1]  
Al-Haddad M, 2010, J PANCREAS, V11, P1
[2]   Early morbidity of endoscopic ultrasound: 13 Years' experience at a referral center [J].
Bournet, B ;
Migueres, I ;
Delacroix, M ;
Vigouroux, D ;
Bornet, JL ;
Escourrou, J ;
Buscail, L .
ENDOSCOPY, 2006, 38 (04) :349-354
[3]   Endoscopic ultrasound-guided fine-needle aspiration biopsy coupled with KRAS mutation assay to distinguish pancreatic cancer from pseudotumoral chronic pancreatitis [J].
Bournet, B. ;
Souque, A. ;
Senesse, P. ;
Assenat, E. ;
Barthet, M. ;
Lesavre, N. ;
Aubert, A. ;
O'Toole, D. ;
Hammel, P. ;
Levy, P. ;
Ruszniewski, P. ;
Bouisson, M. ;
Escourrou, J. ;
Cordelier, P. ;
Buscail, L. .
ENDOSCOPY, 2009, 41 (06) :552-557
[4]   Interventional endoscopic ultrasound in pancreatic diseases [J].
Buscail, Louis ;
Faure, Patrick ;
Bournet, Barbara ;
Selves, Janick ;
Escourrou, Jean .
PANCREATOLOGY, 2006, 6 (1-2) :7-16
[5]   Competitive allele specific TaqMan PCR for KRAS, BRAF and EGFR mutation detection in clinical formalin fixed paraffin embedded samples [J].
Didelot, Audrey ;
Le Corre, Delphine ;
Luscan, Armelle ;
Cazes, Aurelie ;
Pallier, Karine ;
Emile, Jean-Francois ;
Laurent-Puig, Pierre ;
Blons, Helene .
EXPERIMENTAL AND MOLECULAR PATHOLOGY, 2012, 92 (03) :275-280
[6]   Pancreatic Cancer [J].
Hidalgo, Manuel .
NEW ENGLAND JOURNAL OF MEDICINE, 2010, 362 (17) :1605-1617
[7]  
Kato K, 2012, GASTROENT RES PRACT, V243524, P1
[8]   EUS-FNA Mutational Analysis in Differentiating Autoimmune Pancreatitis and Pancreatic Cancer [J].
Khalid, Asif ;
Dewitt, John ;
Ohori, N. Paul ;
Chen, Jey-Hsin ;
Fasanella, Kenneth E. ;
Sanders, Michael ;
McGrath, Kevin M. ;
Nikiforova, Marina .
PANCREATOLOGY, 2011, 11 (05) :482-486
[9]   Targeted KRAS Mutation Assessment on Patient Tumor Histologic Material in Real Time Diagnostics [J].
Kotoula, Vassiliki ;
Charalambous, Elpida ;
Biesmans, Bart ;
Malousi, Andigoni ;
Vrettou, Eleni ;
Fountzilas, George ;
Karkavelas, George .
PLOS ONE, 2009, 4 (11)
[10]   KRAS mutations as an independent prognostic factor in patients with advanced colorectal cancer treated with cetuximab [J].
Lievre, Astrid ;
Bachet, Jean-Baptiste ;
Boige, Valerie ;
Cayre, Anne ;
Le Corre, Delphine ;
Buc, Emmanuel ;
Ychou, Marc ;
Bouche, Olivier ;
Landi, Bruno ;
Louvet, Christophe ;
Andre, Thierry ;
Bibeau, Frederic ;
Diebold, Marie-Daniele ;
Rougier, Philippe ;
Ducreux, Michel ;
Tomasic, Gorana ;
Emile, Jean-Francois ;
Penault-Llorca, Frederique ;
Laurent-Puig, Pierre .
JOURNAL OF CLINICAL ONCOLOGY, 2008, 26 (03) :374-379