Abstract
BackgroundEndoscopic ultrasound-guided fine needle aspiration (EUS-FNA) technology is widely used for the diagnosis of pancreatic masses. However, in some cases, inadequate tissue volume or difficulty of morphological diagnosis are constraining factors for adequate cytopathological evaluation. K-ras mutation is the most frequently acquired genetic abnormality, occurring in approximately 90% of all patients with pancreatic ductal adenocarcinoma (PDAC). In the present study, the clinical utility of residual liquid-based cytology (LBC) specimens obtained using EUS-FNA for K-ras mutation analysis was evaluated.MethodsIn this study, 81 patients with pancreatic lesions were examined. The cell block (CB) specimens separated from EUS-FNA samples were morphologically evaluated by hematoxylin–eosin (HE) staining. Final diagnoses were confirmed by CB specimens, surgical resection specimens, diagnostic imaging, and clinical follow-up. Genomic DNA of residual LBC specimens stored at 4°C for several months were extracted and assessed for K-ras mutations using a fluorescence resonance energy transfer-based preferential homoduplex formation assay.ResultsK-ras mutation analysis using residual LBC samples was successful in all cases. The sensitivity, specificity, and accuracy of CB examination alone were 77.4%, 100%, and 81.3%, respectively, and those of the combination of CB examination and K-ras mutation analysis were 90.3%, 92.3%, and 90.7%, respectively. Furthermore, K-ras mutations were detected in 8 (57.1%) of 14 PDAC samples for which the CB results were inconclusive.ConclusionThese findings suggest that K-ras mutation analysis using residual LBC specimens improves the diagnostic accuracy of EUS-FNA.
Highlights
Pancreatic ductal adenocarcinoma (PDAC) is a major cause of cancer-related mortality worldwide with a 5-year survival rate of less than 5% and median survival of less than 1 year [1, 2]
K-ras mutation analysis using residual liquid-based cytology (LBC) samples was successful in all cases
The sensitivity, specificity, and accuracy of cell block (CB) examination alone were 77.4%, 100%, and 81.3%, respectively, and those of the combination of CB examination and K-ras mutation analysis
Summary
Pancreatic ductal adenocarcinoma (PDAC) is a major cause of cancer-related mortality worldwide with a 5-year survival rate of less than 5% and median survival of less than 1 year [1, 2]. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is widely used for the histological diagnosis of abdominal tumors, especially pancreatic lesions [3]. EUS-FNA is the most useful tool to distinguish PDAC from inflammatory conditions and rare primary pancreatic tumors to avoid unnecessary surgery. The reported diagnostic rate of EUS-FNA for solid pancreatic mass exceeds 70% [3–5]. Improvement in the diagnostic accuracy of EUS-FNA will improve patient prognosis and facilitate treatment of patients with suspected pancreatic cancer. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) technology is widely used for the diagnosis of pancreatic masses. K-ras mutation is the most frequently acquired genetic abnormality, occurring in approximately 90% of all patients with pancreatic ductal adenocarcinoma (PDAC). The clinical utility of residual liquid-based cytology (LBC) specimens obtained using EUS-FNA for K-ras mutation analysis was evaluated
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