Molecular analysis of pancreatic cystic neoplasm in routine clinical practice

• 作者: Raquel Herranz Pérez Felipe de la Morena López Pedro L Majano Rodríguez Francisca Molina Jiménez Lorena Vega Piris Cecilio Santander Vaquero
• 来源期刊: 世界胃肠内镜杂志:英文版(电子版)
• 学科: 医学
• 关键词: Pancreatic cysts Molecular analysis Next-generation sequencing Mucinous cyst Pancreatic cyst fluid Pancreatic cancer
• 年，卷（期）: 2021,（2）
• 页码范围: 56-71
• 页数: 16页
• 分类号: R73

摘要

BACKGROUND Cystic pancreatic lesions consist of a wide variety of lesions that are becoming increasingly diagnosed with the growing use of imaging techniques.Of these,mucinous cysts are especially relevant due to their risk of malignancy.However,morphological findings are often suboptimal for their differentiation.Endoscopic ultrasound fine-needle aspiration(EUS-FNA)with molecular analysis has been suggested to improve the diagnosis of pancreatic cysts.AIM To determine the impact of molecular analysis on the detection of mucinous cysts and malignancy.METHODS An 18-month prospective observational study of consecutive patients with pancreatic cystic lesions and an indication for EUS-FNA following European clinical practice guidelines was conducted.These cysts included those>15 mm with unclear diagnosis,and a change in follow-up or with concerning features in which results might change clinical management.EUS-FNA with cytological,biochemical and glucose and molecular analyses with next-generation sequencing were performed in 36 pancreatic cysts.The cysts were classified as mucinous and non-mucinous by the combination of morphological,cytological and biochemical analyses when surgery was not performed.Malignancy was defined as cytology positive for malignancy,high-grade dysplasia or invasive carcinoma on surgical specimen,clinical or morphological progression,metastasis or death related to neoplastic complications during the 6-mo follow-up period.Next-generation sequencing results were compared for cyst type and malignancy.RESULTS Of the 36 lesions included,28(82.4%)were classified as mucinous and 6(17.6%)as non-mucinous.Furthermore,5(13.9%)lesions were classified as malignant.The amount of deoxyribonucleic acid obtained was sufficient for molecular analysis in 25(69.4%)pancreatic cysts.The amount of intracystic deoxyribonucleic acid was not statistically related to the cyst fluid volume obtained from the lesions.Analysis of KRAS and/or GNAS showed 83.33%[95%confidence interval(CI):63.34-100]sensitivity,60%(95%CI:7.0