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  • Title: Clinical impact of K-ras mutation analysis in EUS-guided FNA specimens from pancreatic masses.
    Author: Ogura T, Yamao K, Sawaki A, Mizuno N, Hara K, Hijioka S, Niwa Y, Tajika M, Kondo S, Shimizu Y, Bhatia V, Higuchi K, Hosoda W, Yatabe Y.
    Journal: Gastrointest Endosc; 2012 Apr; 75(4):769-74. PubMed ID: 22284089.
    Abstract:
    BACKGROUND: 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. OBJECTIVE: To evaluate clinical impact of K-ras mutation analysis in EUS-FNA specimens from pancreatic masses. DESIGN: Prospective registration, single-center study. SETTING: Tertiary referral center. PATIENTS: 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. INTERVENTION: EUS-FNA, Cycleave polymerase chain reaction. MAIN OUTCOME MEASUREMENTS: Improvement of the diagnostic accuracy by K-ras mutation analysis; absence of K-ras mutations in non-PDAC masses. RESULTS: 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. LIMITATIONS: Single-center study. CONCLUSIONS: 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.
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