Performance characteristics of molecular (DNA) analysis for the diagnosis of mucinous pancreatic cysts
Performance characteristics of molecular (DNA) analysis for the diagnosis of mucinous pancreatic cysts
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DOI：
10.1016/j.gie.2013.05.026
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发表时间：
2014-01-01
影响因子：
7.7
通讯作者：
Imperiale, Thomas F.
中科院分区：
文献类型：
--
作者：
Al-Haddad, Mohammad;DeWitt, John;Imperiale, Thomas F.
背景资料：由于超声内镜引导下细针穿刺活检（EUS-FNA）细胞学检查的敏感性较差，胰腺黏液囊肿（MPCs）的诊断具有挑战性。目的：量化可疑低危MPCs的分子（DNA）分析的检测特征。设计：2008年至2011年进行的前瞻性队列研究。设置：学术转诊中心。患者：对可疑MPCs进行EUS-FNA的连续性患者。干预：EUS-FNA和囊液的分子（DNA）分析。主要结果测量：分子分析的敏感性和特异性的诊断MPCs的外科病理学标准在切除的囊肿。结果：可疑MPCs患者进行EUS-FNA和囊液DNA分析。48例患者（17%）进行了手术切除，38例（79%）证实为粘液性病理。在该组中，分子分析在识别MPC方面的敏感性为50%，特异性为80%（准确性为56.3%）。分子分析与囊液癌胚抗原（CEA）和细胞学的组合导致更高的MPC诊断性能比其任何一个单独的组成部分，灵敏度，特异性和准确性分别为73.7%，70%和72.9%。分子分析和CEA/cytology in this group.Limitations之间的准确性没有显着差异：单中心experience.Conclusion：分子分析艾滋病在MPC的诊断时，细胞学是nondiagnosis或囊液不足的CEA或其水平是不确定的。我们的研究结果不支持常规使用分子分析，应在回顾影像学表现和囊液研究后选择性使用。需要进一步的研究来评估DNA在恶性囊肿中的表现。
Background: Diagnosis of mucinous pancreatic cysts (MPCs) is challenging due to the poor sensitivity of cytology provided by EUS-guided-FNA (EUS-FNA).Objective: To quantify the test characteristics of molecular (DNA) analysis in suspected low-risk MPCs.Design: A prospective cohort study performed in between 2008 and 2011.Setting: Academic referral center.Patients: Consecutive patients who underwent EUS-FNA of suspected MPCs.Intervention: EUS-FNA and molecular (DNA) analysis of cyst fluid.Main Outcome Measurements: The sensitivity and specificity of molecular analysis in the diagnosis of MPCs using the criterion standard of surgical pathology in resected cysts.Results: Patients with suspected MPCs underwent EUS-FNA and cyst fluid DNA analysis. Surgical resection was performed in 48 patients (17%), confirming a mucinous pathology in 38 (79%). In this group, molecular analysis had a sensitivity of 50% and a specificity of 80% in identifying MPCs (accuracy of 56.3%). The combination of molecular analysis with cyst fluid carcinoembryonic antigen (CEA) and cytology resulted in higher MPC diagnostic performance than either one of its individual components, with a sensitivity, specificity, and accuracy of 73.7%, 70%, and 72.9%, respectively. There was no significant difference in accuracy between molecular analysis and CEA/cytology in this group.Limitations: Single-center experience.Conclusion: Molecular analysis aids in the diagnosis of MPCs when cytology is nondiagnostic or cyst fluid is insufficient for CEA or its level is indeterminate. Our results do not support the routine use of molecular analysis, which should be used selectively after review of imaging findings and cyst fluid studies. Further studies are needed to assess DNA's performance in malignant cysts.