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Medline ® Abstract for Reference 68

of '超声内镜在外分泌胰腺癌分期中的应用'

Clinical impact of K-ras mutation analysis in EUS-guided FNA specimens from pancreatic masses.
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
Gastrointest Endosc. 2012;75(4):769.
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.
Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.