Quantitative analysis of K-ras gene mutation in pancreatic tissue obtained by endoscopic ultrasonography-guided fine needle aspiration: clinical utility for diagnosis of pancreatic tumor
Quantitative analysis of K-ras gene mutation in pancreatic tissue obtained by endoscopic ultrasonography-guided fine needle aspiration: clinical utility for diagnosis of pancreatic tumor
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DOI：
10.1111/j.1572-0241.2002.05980.x
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发表时间：
2002-09
影响因子：
9.8
通讯作者：
M. Tada;Y. Komatsu;T. Kawabe;N. Sasahira;H. Isayama;N. Toda;Y. Shiratori;M. Omata
中科院分区：
文献类型：
--
作者：
M. Tada;Y. Komatsu;T. Kawabe;N. Sasahira;H. Isayama;N. Toda;Y. Shiratori;M. Omata
目的：超声内镜引导下的细针抽吸术（EUS-FNA）已在胰腺癌的诊断中得到确立。探讨将病理诊断与K-ras突变基因分析相结合的方法，以提高诊断的准确性。方法：对34例胰腺肿块患者（其中26例为腺癌，8例为慢性胰腺炎）进行EUS-FNA检查。对 EUS-FNA 获得的标本以及 ERCP 获得的胰液中的突变 ras 基因进行半定量分析。结果：在胰腺癌病例的 26 份 EUS-FNA 标本中的 20 份 (77%) 和 19 份胰液中的 12 份 (63%) 中检测到高含量的突变基因 (超过总 ras 基因的 2%)。 26 名胰腺癌患者中，有 16 名 (62%) 通过 EUS-FNA 进行了恶性肿瘤的细胞学诊断。联合细胞学和EUS-FNA分子方法的26例中，癌的准确诊断率为21例（81%），而结合胰液分子分析，则增加到26例中的23例（88%）。相比之下，在胰腺良性病变患者中，尽管细胞学检查可疑，但突变基因不存在或水平较低。结论：突变ras基因的定量分析补充了EUS-FNA和ERCP的常规细胞学检查。检测到大量突变可能代表胰腺癌，而缺乏突变则增加了良性病变的可能性。
OBJECTIVES:Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) has become established in the diagnosis of pancreatic cancer. The combination of pathological diagnosis and analysis for mutant K-ras gene was investigated to improve the accuracy of diagnosis.METHODS:EUS-FNA was performed in 34 patients with pancreatic masses (26 adenocarcinomas and eight chronic pancreatitis). Mutant ras gene was analyzed semiquantitatively in the specimens obtained by EUS-FNA as well as in pancreatic juice obtained by ERCP.RESULTS:Mutant gene was detected at high amounts (more than 2% of total ras genes) in 20 of 26 (77%) specimens of EUS-FNA and in 12 of 19 (63%) of pancreatic juice in cases with pancreatic carcinoma. Cytological diagnosis of malignancy by EUS-FNA was found in 16 of 26 (62%) patients with pancreatic cancer. Accurate diagnosis of the carcinoma was 21 of 26 (81%) by combined cytology and molecular method of EUS-FNA, and increased to 23 of 26 (88%) by adding molecular analysis of pancreatic juice. In contrast, mutant gene was absent or low level despite suspicious cytology in patients with benign pancreatic lesion.CONCLUSION:Quantitative analysis of mutant ras gene supplemented conventional cytology of EUS-FNA and ERCP. Detection of mutation at high amounts may represent pancreatic cancer, whereas its absence increased the possibility of benign lesion.