Clinical Impact of KRAS and GNAS Analysis Added to CEA and Cytology in Pancreatic Cystic Fluid Obtained by EUS-FNA.
Dig Dis Sci
; 63(9): 2351-2361, 2018 09.
Article
en En
| MEDLINE
| ID: mdl-29796909
ABSTRACT
BACKGROUND:
Pancreatic cysts are common incidental findings with malignant potential, raising diagnostic and treatment dilemmas.AIMS:
To determine the added value of KRAS and GNAS mutation analysis on cyst classification and decision making.METHODS:
We analyzed 52 frozen samples of pancreatic cystic fluid obtained by EUS-FNA between 2008 and 2014. In addition to cytology and CEA, mutations of GNAS (exons 8 and 9) and KRAS (exons 2 and 3) genes were analyzed using Sanger sequencing.RESULTS:
There were 52 patients, 67% females, with a mean age of 59 ± 15 years (29-91). Cysts were classified as mucinous in 21 patients (40%) (14 low-risk, seven malignant) and non-mucinous in 31 patients (60%). After EUS-FNA, 11 patients had surgery, six had chemotherapy or palliation, one had endoscopic drainage, and 34 are on follow-up after a mean of 57 months. KRAS mutation was detected in nine and GNAS in two samples. Patients harboring cysts with KRAS mutations were older (p = 0.01), cysts were more commonly mucinous (p = 0.001) and malignant (p = 0.01). KRAS mutations were present in both low-risk and malignant mucinous lesions. For identifying mucinous lesions, CEA > 192 ng/mL performed better (AUC ROC = 93%), whereas for malignant/high-risk mucinous lesions, EUS imaging had the best accuracy (AUC ROC = 88%). After molecular analysis, a modification in cyst classification occurred in ten patients, but was correct in only two, a pseudocyst re-classified as IPMN and a malignant cyst as a non-mucinous cyst.CONCLUSIONS:
In this cohort of patients with pancreatic cysts, KRAS and GNAS mutations had no significant diagnostic benefit in comparison with conventional testing.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Quiste Pancreático
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Neoplasias Pancreáticas
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Análisis Mutacional de ADN
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Carcinoma
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Antígeno Carcinoembrionario
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Biomarcadores de Tumor
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Proteínas Proto-Oncogénicas p21(ras)
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Cromograninas
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Neoplasias Quísticas, Mucinosas y Serosas
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Subunidades alfa de la Proteína de Unión al GTP Gs
Tipo de estudio:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Dig Dis Sci
Año:
2018
Tipo del documento:
Article
País de afiliación:
Portugal