Endoscopic ultrasound-guided fine-needle aspiration biopsy coupled withKRASmutation assay to distinguish pancreatic cancer from pseudotumoral chronic pancreatitis
| Autor: | Ariane Aubert, Barbara Bournet, Eric Assenat, Pierre Senesse, Jean Escourrou, Pierre Cordelier, Marc Barthet, M. Bouisson, Philippe Lévy, Louis Buscail, Philippe Ruszniewski, Pascal Hammel, Dermot O'Toole, Anny Souque, N. Lesavre |
|---|---|
| Přispěvatelé: | Service de Gastro-entérologie et Nutrition[Rangueil], CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Institut de médecine moléculaire de Rangueil (I2MR), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-IFR150-Institut National de la Santé et de la Recherche Médicale (INSERM), CRLC Val d'Aurelle-Paul Lamarque, CRLCC Val d'Aurelle - Paul Lamarque, Department of Gastroenterology, Hôpital Nord [CHU - APHM], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Pôle Maladies de l'appareil digestif [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées- Institut Fédératif de Recherche Bio-médicale Institution (IFR150)-Institut National de la Santé et de la Recherche Médicale (INSERM), Simon, Marie Francoise |
| Rok vydání: | 2009 |
| Předmět: |
Male
Pathology medicine.medical_specialty Pancreatic disease Biopsy Fine-Needle medicine.disease_cause Gastroenterology Endosonography Diagnosis Differential Proto-Oncogene Proteins p21(ras) 03 medical and health sciences 0302 clinical medicine Pancreatitis Chronic Proto-Oncogene Proteins Internal medicine Pancreatic cancer medicine Pancreatic mass Humans [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] 10. No inequality Pancreas Aged medicine.diagnostic_test business.industry Middle Aged medicine.disease digestive system diseases 3. Good health Pancreatic Neoplasms KRAS Mutation Analysis Fine-needle aspiration Cytopathology 030220 oncology & carcinogenesis Mutation ras Proteins Pancreatitis Female [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] 030211 gastroenterology & hepatology KRAS business |
| Zdroj: | Endoscopy Endoscopy, Thieme Publishing, 2009, 41 (6), pp.552-7. ⟨10.1055/s-0029-1214717⟩ Endoscopy, 2009, 41 (6), pp.552-7. ⟨10.1055/s-0029-1214717⟩ |
| ISSN: | 1438-8812 0013-726X |
| Popis: | International audience; BACKGROUND AND STUDY AIMS: Differential diagnosis between pancreatic adenocarcinoma (PADC) and pseudotumoral forms of chronic pancreatitis remains difficult. Mutation of KRAS oncogene is present in 75% to 95% of PADC. This study aimed to evaluate whether the combined analysis of KRAS mutation with cytopathological findings from endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) might improve discrimination between PADC and chronic pancreatitis. PATIENTS AND METHODS: This prospective multicenter study included 178 patients with solid pancreatic masses (men 104, women 74; mean age 64.5 years). Cytopathological examination and KRAS mutation analysis (codon-12 and codon-13, restriction fragment length polymorphism [RFLP] and direct sequencing) were performed on EUS-FNAB material. Final diagnoses were obtained on EUS-FNAB analysis and/or a second biopsy and/or clinical follow-up and/or surgery: PADC, n = 129; chronic pancreatitis, n = 27; other pancreatic neoplasms, n = 16; and benign lesions, n = 6. RESULTS: KRAS status analysis was successful in all EUS-FNAB samples. Codon-12 KRAS point mutation was found in 66% of PADC samples. No case of chronic pancreatitis displayed KRAS mutation. Sensitivity, specificity, positive and negative predictive values, and overall accuracy of cytopathology alone for diagnosis of PADC versus chronic pancreatitis were 83%, 100%, 100%, 56% and 86%, respectively. When KRAS mutation analysis was combined with cytopathology, these values reached 88%, 100%, 100%, 63% and 90% respectively. CONCLUSION: Although the value of KRAS analysis in addition to EUS-FNAB is limited for distinguishing pancreatic mass lesions, when chronic pancreatitis presented as a pseudotumor a negative finding (wild-type KRAS), was useful in strongly suggesting a benign lesion. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|