Park Joo Kyung, Lee Yoon Jung, Lee Jong Kyun, Lee Kyu Taek, Choi Yoon-La, Lee Kwang Hyuck
Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Oncotarget. 2017 Jan 10;8(2):3519-3527. doi: 10.18632/oncotarget.13864.
EUS-FNA becomes one of the most important diagnostic modalities for PDACs. However, acquired tissue specimens were sometimes insufficient to make a definite cytological diagnosis. On the other hand, KRAS mutation is the most frequently acquired genetic alteration found more than 90% of PDACs. To investigate the way to improve diagnostic accuracy for PDACs using both cytological examination and KRAS mutation analysis would be a great help. Therefore, the aims of this study were to evaluate usefulness of conventional cytological examination combined with KRAS mutation analysis with modified PCR technology to improve the sensitivity and the accuracy. We enrolled 43 patients with solid pancreatic masses and 86 EUS-FNA specimens were obtained. During the EUS-FNA, the needle catheter was flushed with 2 cc of saline and the washed fluid was collected for KRAS mutation analysis for the first 2 passes; PNAClamp™ KRAS Mutation Detection Kit. There were 46 specimens from the 23 PDACs and 40 specimens from the 20 other pancreatic diseases. The sensitivity, specificity and accuracy were as follows; conventional cytopathologic examination: 63%, 100% and 80%; combination of cytopathologic examination and K-ras mutation analysis: 87%, 100% and 93%. Furthermore, KRAS mutation was detected 11 out of 17 PDAC samples whose cytopathology results were inconclusive. KRAS mutation analysis with PNAClamp™ technique using washing fluid from EUS-FNA along with cytological examination may not only improve the diagnostic accuracy of PDACs, but also establish the platform using genetic analysis which would be helpful as diagnostic modality for PDACs.
超声内镜引导下细针穿刺活检（EUS-FNA）已成为胰腺导管腺癌（PDAC）最重要的诊断方法之一。然而，获取的组织标本有时不足以做出明确的细胞学诊断。另一方面，KRAS突变是在超过90%的PDAC中最常见的基因改变。研究如何通过细胞学检查和KRAS突变分析来提高PDAC的诊断准确性将大有帮助。因此，本研究的目的是评估传统细胞学检查联合改良PCR技术进行KRAS突变分析的有效性，以提高敏感性和准确性。我们纳入了43例胰腺实性肿块患者，获取了86份EUS-FNA标本。在EUS-FNA过程中，用2毫升生理盐水冲洗针导管，并在前2次穿刺时收集冲洗液用于KRAS突变分析；采用PNAClamp™ KRAS突变检测试剂盒。其中23例PDAC患者的标本有46份，其他20种胰腺疾病的标本有40份。敏感性、特异性和准确性如下：传统细胞病理学检查分别为63%、100%和80%；细胞病理学检查与K-ras突变分析联合为87%、100%和93%。此外，在17例细胞病理学结果不明确的PDAC样本中，有11例检测到KRAS突变。使用EUS-FNA冲洗液的PNAClamp™技术进行KRAS突变分析并结合细胞学检查，不仅可以提高PDAC的诊断准确性，还可以建立一个利用基因分析的平台，这将有助于作为PDAC的诊断方法。
