Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
Gastrointest Endosc. 2012 Apr;75(4):769-74. doi: 10.1016/j.gie.2011.11.012. Epub 2012 Jan 28.
EUS-guided FNA (EUS-FNA) is considered optimal for differentially diagnosing pancreatic masses. However, the sensitivity of EUS-FNA ranges from 65% to 95%, respectively, which requires improvement.
To evaluate clinical impact of K-ras mutation analysis in EUS-FNA specimens from pancreatic masses.
Prospective registration, single-center study.
Tertiary referral center.
This study involved 394 consecutive patients with pancreatic masses (307 pancreatic ductal adenocarcinomas [PDACs], 47 pancreatic inflammatory lesions, and 40 other types of tumors) who underwent EUS-FNA and analysis of K-ras mutations.
EUS-FNA, Cycleave polymerase chain reaction.
Improvement of the diagnostic accuracy by K-ras mutation analysis; absence of K-ras mutations in non-PDAC masses.
K-ras mutations were detected in 266 of 307 PDAC aspirates (87%) and in 3 of 87 non-PDAC masses (3%). K-ras mutations were detected in 18 of 39 patients (46%) who remained cytohistopathologically undiagnosed. The sensitivity, specificity, positive and negative predictive values, and accuracy of cytohistopathological and K-ras mutation analyses alone were 87%, 100%, 100%, 54%, and 89%, respectively, and, when combined, were 93%, 100%, 100%, 68%, and 94%, respectively. Adding K-ras mutation analysis to standard cytohistopathological assessment increased the sensitivity and accuracy of EUS-FNA by 6% (P < .001) and 5% (P < .001), respectively.
Single-center study.
K-ras mutation analysis may be helpful in patients with suspected PDAC yet inconclusive EUS-FNA findings. K-ras mutations were extremely rare in pancreatic inflammation and other pancreatic tumors.
EUS 引导下的细针抽吸（EUS-FNA）被认为是鉴别胰腺肿块的最佳方法。然而，EUS-FNA 的敏感性分别为 65%至 95%，需要提高。
评估 K-ras 基因突变分析对 EUS-FNA 胰腺肿块标本的临床影响。
前瞻性注册，单中心研究。
三级转诊中心。
本研究纳入了 394 例连续的胰腺肿块患者（307 例胰腺导管腺癌 [PDAC]、47 例胰腺炎症性病变和 40 例其他类型肿瘤），他们接受了 EUS-FNA 和 K-ras 基因突变分析。
EUS-FNA、Cycleave 聚合酶链反应。
K-ras 基因突变分析提高诊断准确性；非 PDAC 肿块中不存在 K-ras 突变。
在 307 例 PDAC 抽吸物中检测到 266 例（87%）和 87 例非 PDAC 肿块中 3 例（3%）的 K-ras 突变。在 39 例仍未通过细胞组织病理学诊断的患者中，有 18 例（46%）检测到 K-ras 突变。单独进行细胞组织病理学和 K-ras 基因突变分析的敏感性、特异性、阳性和阴性预测值及准确性分别为 87%、100%、100%、54%和 89%，联合应用时分别为 93%、100%、100%、68%和 94%。将 K-ras 基因突变分析添加到标准细胞组织病理学评估中，分别提高了 EUS-FNA 的敏感性和准确性 6%（P<0.001）和 5%（P<0.001）。
单中心研究。
K-ras 基因突变分析可能有助于疑似 PDAC 但 EUS-FNA 结果不确定的患者。K-ras 突变在胰腺炎症和其他胰腺肿瘤中极为罕见。
