Back to Search
Start Over
Preoperative GNAS and KRAS testing in the diagnosis of pancreatic mucinous cysts.
- Source :
-
Clinical cancer research : an official journal of the American Association for Cancer Research [Clin Cancer Res] 2014 Aug 15; Vol. 20 (16), pp. 4381-9. Date of Electronic Publication: 2014 Jun 17. - Publication Year :
- 2014
-
Abstract
- Purpose: Management guidelines for pancreatic intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN) are based on the assumption that mucinous cysts can be accurately distinguished from other pancreatic cystic lesions. Previous studies using surgical material have identified recurrent mutations in GNAS and KRAS in pancreatic mucinous neoplasms. Yet, the diagnostic utility of testing for both genes in pancreatic cyst fluid obtained by endoscopic ultrasound-fine-needle aspiration (EUS-FNA) remains unclear.<br />Experimental Design: GNAS and KRAS testing was performed on EUS-FNA pancreatic cyst fluid from 91 pancreatic cysts: 41 IPMNs, 9 IPMNs with adenocarcinoma, 16 MCNs, 10 cystic pancreatic neuroendocrine tumors (PanNET), 9 serous cystadenomas (SCA), 3 retention cysts, 2 pseudocysts, and 1 lymphoepithelial cyst.<br />Results: Mutations in GNAS were detected in 16 (39%) IPMNs and 2 (22%) IPMNs with adenocarcinoma. KRAS mutations were identified in 28 (68%) IPMNs, 7 (78%) IPMNs with adenocarcinoma, and 1 (6%) MCN. Mutations in either gene were present in 34 (83%) IPMNs, 8 (89%) IPMNs with adenocarcinoma, and 1 (6%) MCN. No mutations were found in cystic PanNETs, SCAs, retention cysts, pseudocysts, and a lymphoepithelial cyst. GNAS and KRAS mutations had 100% specificity [95% confidence interval (CI), 0.83-1.00] but 65% sensitivity (95% CI, 0.52-0.76) for mucinous differentiation. Among IPMNs, mutations in either gene had 98% specificity (95% CI, 0.86-1.00) and 84% sensitivity (95% CI, 0.70-0.92).<br />Conclusions: The combination of GNAS and KRAS testing was highly specific and sensitive for IPMNs; however, the lack of sensitivity for MCNs highlights the need for additional markers to improve the detection of pancreatic mucinous neoplasms.<br /> (©2014 American Association for Cancer Research.)
- Subjects :
- Adenocarcinoma diagnosis
Adenocarcinoma genetics
Adenocarcinoma, Mucinous diagnosis
Adenocarcinoma, Mucinous genetics
Adult
Aged
Aged, 80 and over
Biopsy, Fine-Needle
Carcinoma, Pancreatic Ductal diagnosis
Carcinoma, Pancreatic Ductal genetics
Carcinoma, Papillary diagnosis
Carcinoma, Papillary genetics
Chromogranins
Cyst Fluid chemistry
Cyst Fluid metabolism
Cystadenoma, Serous diagnosis
Cystadenoma, Serous genetics
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neoplasm Staging
Pancreatic Cyst metabolism
Pancreatic Neoplasms genetics
Preoperative Care
Prognosis
Proto-Oncogene Proteins p21(ras)
Young Adult
Biomarkers, Tumor genetics
GTP-Binding Protein alpha Subunits, Gs genetics
Mutation genetics
Pancreatic Cyst pathology
Pancreatic Neoplasms diagnosis
Proto-Oncogene Proteins genetics
ras Proteins genetics
Subjects
Details
- Language :
- English
- ISSN :
- 1557-3265
- Volume :
- 20
- Issue :
- 16
- Database :
- MEDLINE
- Journal :
- Clinical cancer research : an official journal of the American Association for Cancer Research
- Publication Type :
- Academic Journal
- Accession number :
- 24938521
- Full Text :
- https://doi.org/10.1158/1078-0432.CCR-14-0513