Diagnostic approach to pancreatic tumors with the specimens of endoscopic ultrasound-guided fine needle aspiration
Diagnostic approach to pancreatic tumors with the specimens of endoscopic ultrasound-guided fine needle aspiration
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DOI：
10.1111/j.1440-1827.2010.02527.x
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发表时间：
2010-05-01
影响因子：
2.2
通讯作者：
Yatabe, Yasushi
中科院分区：
文献类型：
--
作者：
Hosoda, Waki;Takagi, Tadayuki;Yatabe, Yasushi
超声内镜引导下细针穿刺（EUS-FNA）使临床医生能够对胰腺肿瘤进行组织学诊断。然而，EUS-FNA标本往往导致微小的碎片组织，因此辅助工具是必要的。使用CK 7、CDX 2、神经内分泌标记物和KRAS突变分析的免疫染色，我们检查了57个FNA细胞块切片和61个切除标本（25个浸润性导管癌、25个内分泌肿瘤和11个腺泡细胞肿瘤）。在大多数配对中，EUS-FNA和手术标本之间的诊断是一致的，使用以下标准：神经内分泌标志物阴性，CK 7阳性，突变的KRAS基因为浸润性导管癌;神经内分泌标志物弥漫阳性，CK 7和CDX 2阴性，野生型KRAS基因为分化良好的内分泌肿瘤;腺泡细胞癌的神经内分泌标志物不超过灶性阳性，CK 7和CDX 2染色模式多样，KRAS基因为野生型。CK 7和/或CDX 2的表达除了KRAS突变外，在内分泌癌中偶尔可见，但在分化良好的内分泌肿瘤中不存在，这表明内分泌肿瘤中的导管分化可能是侵袭性疾病的预测因子。这些标记物的有用性通过13例胰腺肿瘤的前瞻性研究得到证实。尽管选择性极低，但这些标记物有助于从主要胰腺肿瘤的EUS-FNA标本中进行诊断。
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has enabled clinicians to histologically diagnose pancreatic tumors. However, EUS-FNA specimens often result in tiny fragmented tissues, so auxiliary utilities are necessary. Using immunostaining of CK7, CDX2, neuroendocrine markers and KRAS mutation analysis, we examined 57 FNA cell block sections and 61 surgically-resected specimens (25 invasive ductal carcinomas, 25 endocrine tumors, and 11 acinar cell tumors). In the majority of the matched pairs, the diagnoses between EUS-FNA and surgical specimens were concordant using the following criteria: neuroendocrine markers negative, CK7 positive, and mutated KRAS gene for invasive ductal carcinomas; neuroendocrine markers diffusely positive, CK7 and CDX2 negative, and wild-type KRAS gene for well-differentiated endocrine tumors; and neuroendocrine markers no more than focal positive, CK7 and CDX2 with various staining patterns, and wild-type KRAS gene for acinar cell carcinomas. Expression of CK7 and/or CDX2 in addition to KRAS mutations were occasionally seen in endocrine carcinomas, but not in well-differentiated endocrine tumors, suggesting that ductal differentiation in an endocrine tumor may be a predictor of aggressive disease. The usefulness of these markers was confirmed using 13 additional pancreatic tumors, prospectively. Although minimal in selection, these markers are helpful in making diagnosis from EUS-FNA specimens of the major pancreatic tumors.