Kras mutation analysis of fine needle aspirate under EUS guidance facilitates risk stratification of patients with pancreatic mass
Kras mutation analysis of fine needle aspirate under EUS guidance facilitates risk stratification of patients with pancreatic mass
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DOI：
10.1097/mcg.0b013e31805905e9
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发表时间：
2007-11-01
影响因子：
2.9
通讯作者：
Forero, Elias
中科院分区：
文献类型：
--
作者：
Maluf-Filho, Fauze;Kumar, Atul;Forero, Elias
目的：内镜超声-细针穿刺细胞学（EUS-FNAC）诊断胰腺癌的准确性不理想。kras癌基因的突变激活几乎普遍存在于胰腺癌组织中。因此，我们调查，如果突变kras基因的EUS-FNAC吸出物的分析补充细胞病理学胰腺癌（PAC）的诊断方法：从74例胰腺肿块EUS-FNAC标本进行了分析，使用聚合酶链反应-限制性片段长度多态性和MvaI限制性内切酶的存在下，kras基因突变的密码子12。诊断是基于手术病理或长期随访（中位数27.8个月）; 57例PAC，I I患者的慢性胰腺炎，和9例患者的无功能的神经内分泌tumors.Results：突变型kras基因的分析，除了细胞病理学允许检测PAC在4个额外的患者相比，单独的细胞病理学。17例患者的细胞病理学和kras突变分析均为PAC阴性，其中6例（35%）患有PAC。其敏感性（90.9% vs. 82.5%）、特异性（47.6% vs. 97.9%）、阳性预测值（89.5% vs. 83.8%）、阴性预测值（98. 1%对94。1%），准确性（89.2%对58.8%）的细胞病理学加kras突变与细胞病理学在数字上是优越的上级，但没有达到统计学significant.Conclusions：分析突变kras基因的存在补充传统的细胞病理学诊断PAC，即使没有细胞病理学家出席，并使用只有3针通过。在细胞病理学阴性的患者中，kras突变的存在代表胰腺癌，而kras突变的缺失增加了良性病变的可能性。
Objectives: The accuracy of endoscopic ultrasound-fine needle aspiration cytology (EUS-FNAC) for the diagnosis of pancreatic cancer is suboptimal. Mutational activation of the kras oncogene is almost universally present in pancreatic cancer tissue. We, therefore, investigated if analysis for mutant kras gene in the EUS-FNAC aspirates supplements cytopathology for the diagnosis of pancreatic adenocarcinoma (PAC).Methods: EUS-FNAC specimens obtained from 74 patients with pancreatic masses were analyzed for the presence of kras mutation on codon 12 using polymerase chain reaction-restriction fragment length polymorphism and MvaI restriction enzyme. Definitive diagnosis was based on surgical pathology or long-term follow-up (median 27.8 mo); 57 patients had PAC, I I patient's chronic pancreatitis, and 9 patient's nonfunctioning neuroendocrine tumors.Results: Analysis of mutant kras gene in addition to cytopathology allowed the detection of PAC in 4 additional patients as compared with cytopathology alone. Cytopathology and kras mutant analysis were negative for PAC in 17 patients of whom 6 patients (35%) had PAC. The respective sensitivity (90.9% vs. 82.5%), specificity (47.6% vs. 97.9%), positive predictive value (89.5% vs. 83.8%), negative predictive value (98. 1 % vs. 94. 1 %), accuracy (89.2% vs. 58.8%) of cytopathology plus kras mutation versus cytopathology were numerically superior but did not reach statistical significance.Conclusions: Analysis for the presence of mutant kras gene supplements conventional cytopathology for the diagnosis of PAC even without a cytopathologist in attendance and using only 3 needle passes. Among patients with negative cytopathology, the presence of kras mutation represents pancreatic cancer while the absence of kras mutation increases the possibility of benign lesion.