Clinical Impact of KRAS and GNAS Analysis Added to CEA and Cytology in Pancreatic Cystic Fluid Obtained by EUS-FNA

Faias, Sandra; Duarte, Marlene; Albuquerque, Cristina; Silva, João Pereira da; Fonseca, Ricardo Roberto de Souza; Roque, Rúben; Pereira, António Dias; Chaves, Paula; Cravo, Marília

doi:10.1007/s10620-018-5128-y

Cited by 28 publications

(22 citation statements)

References 22 publications

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“…Fine needle aspiration (FNA) is an adjunctive procedure performed during EUS that is helpful in reaching a conclusive diagnosis as it allows the aspiration of cystic fluid or tissue collection of a nodule. The collection of cystic fluid by FNA allows to evaluate the CEA levels, cytology, and KRAS/GNAS mutation analyses, improving the diagnostic accuracy of EUS in differentiating malignant from benign PCN [22]. However, FNA is an invasive technique with a relatively low risk of complications, ranging from 0 to 5% [3,5,13,[23][24][25], but rarely may lead to death due to fatal acute pancreatitis [24].…”

Section: Discussionmentioning

confidence: 99%

“…After basal B mode EUS scan of the pancreatic gland, the use of contrast medium considerably increases the diagnostic resolution of the EUS in distinguishing malignant from not malignant PCNs on the basis of the enhancement of specific intra-cystic lesions [14][15][16][17][18][19][20][21]. Several studies [15][16][17][18][19][20][21][22] demonstrated that the CE-EUS is able to clearly detect well-known features indicating a malignant transformation, such as the vascularity within the cystic wall, the presence of septations and mural nodule. Furthermore, CE-EUS in PCNs is able to distinguish a mural nodule from mucin plugs, allowing to discriminate when an FNA is indicated.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Contrast–enhanced endoscopic ultrasound diagnosis of the intraductal papillary mucinous neoplasm

Blanco

Gesuale

Anselmo

et al. 2019

Clin J Gastroenterol

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Pancreatic cystic neoplasms (PCNs) are a frequent incidental finding during an ultrasound or other radiological investigations. As PCNs may have a potential of malignancy, a precise differential diagnosis between a malignant and benign lesion is crucial to define appropriate management of patients with this kind of lesions. Radiology, with computed tomography (CT) and magnetic resonance imaging, may not be conclusive in the diagnostic assessment of PCNs. Endoscopic ultrasound (EUS), a simple and relatively low invasive technique, is able to identify intra-cystic worrisome features suggesting malignancy. Fine-needle aspiration (FNA) of the cystic fluid or of intra-cystic tissue nodule during EUS is an adjunctive procedure for reaching a conclusive diagnosis. As EUS-FNA is burdened by complications, the use of intravenous contrast may increase the diagnostic accuracy of EUS allowing in many cases a correct diagnosis of PCN at high risk of malignancy, without additional risk of complication during the procedure. The present report deals with the case of a cystic lesion found by CT scan in the pancreatic head of a 59-year-old woman suffering from mild epigastric pain. Once submitted to EUS, malignant nature of PCN was suspected due to the finding of a typical worrisome feature, the presence of a mural nodule. The intravenous administration of contrast medium during the EUS confirmed malignancy and the patient was immediately sent to the surgeon for pancreatic resection. Histology revealed an intraductal papillary mucinous neoplasm, with areas of high-grade dysplasia in the main and secondary ducts, progressed toward an invasive carcinoma.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Contrast–enhanced endoscopic ultrasound diagnosis of the intraductal papillary mucinous neoplasm

Blanco

Gesuale

Anselmo

et al. 2019

Clin J Gastroenterol

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“…The triple combination predicted malignant IPMN with an excellent sensitivity of 92% but a limited specificity of only 50% [53]. Furthermore, a mutational analysis was performed on a small cohort using Sanger sequencing to detect any KRAS and GNAS mutations but failed to show a diagnostic advantage even when combined with cytopathology [54].…”

Section: Mutational Analysis: Kras Gnas and Cytopathologymentioning

confidence: 99%

Stratifying Intraductal Papillary Mucinous Neoplasms by Cyst Fluid Analysis: Present and Future

Hao

Takahashi

Snyder

et al. 2020

IJMS

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A significant proportion of patients with intraductal papillary mucinous neoplasms (IPMNs) undergo surgical resection in order to prevent or treat pancreatic cancer at the risk of significant perioperative morbidity. Efforts have been made to stratify the potential risk of malignancy based on the clinical and radiographic features of IPMN to delineate which cysts warrant resection versus observation. An analysis of the cyst fluid obtained by preoperative endoscopic examination appears to be correlative of cyst type and risk, whereas serum markers and radiographic findings have not yet reached a level of sensitivity or specificity that proves they are clinically meaningful. In this review, we investigate the current cyst fluid analysis studies and present those that have shown promise in effectively stratifying high-risk versus low-risk lesions. While new cyst fluid markers continue to be identified, additional efforts in testing panels and marker composites in conjunction with clinical algorithms have also shown promise in distinguishing dysplasia and the risk of malignancy. These should be tested prospectively in order to determine their role in guiding the surveillance of low-risk lesions and to evaluate the new markers detected by proteomics and genetic sequencing.

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“…In addition, newer molecular markers and cytological features are being evaluated in cyst fluid to enhance the diagnostic accuracy of EUS FNA. [9][10][11][12] In this news and views, we will discuss three studies on these newer developments in EUS-guided evaluation of the PCLs. [9][10][11]…”

Section: Pancreaticmentioning

confidence: 99%

“…Faias et al, in a retrospective cohort study, evaluated the role of KRAS and GNAS mutational status in pancreatic cysts in identifying mucinous cysts, particularly high-risk/malignant lesions, and to evaluate its added value in decision making. [9] Fifty-two frozen samples of pancreatic cystic fluid obtained by EUS-FNA between 2008 and 2014 were analyzed. The EUS still images of these 52 patients (67% females, with a mean age of 59 ± 15 years) were reviewed for morphological features such as size, septations, mural nodules, wall thickening, mass, main pancreatic duct features, and its communication with cyst.…”

Section: News and Viewsmentioning

confidence: 99%

Endoscopic Ultrasound‑Guided Diagnosis of Pancreatic Cystic Lesions: Microforceps or Molecular Markers!

Sharma

Rana

2018

Journal of Digestive Endoscopy

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In a multicenter retrospective study done by Basar et al. between 2015 and 2016, newly designed single-use Moray microforceps biopsy (MFB) device (U. S. Endoscopy, Mentor, Ohio) was used along with a 19 G EUS FNA needle for acquisition of cyst wall for histopathology. [10] After performing a detailed EUS that included the number as well as location of PCLs, size, presence or absence of the septations, presence or absence of adjacent mass, and mural nodules, the cyst was punctured using 19G flex FNA needle (Boston Scientific, Marlborough, MA, USA). The cyst fluid was aspirated, and thereafter, without removing the needle, the MFB device was inserted through the needle and pinch biopsy was taken from cyst wall, septations, mural nodules, and from adjacent masses if present. The biopsy was obtained in the order of adjacent mass first followed by mural nodule, cyst wall, and septations, respectively. If biopsy specimen were thought of being insufficient, repeat passes were made. Aspirated cyst fluid was sent for carcinoembryonic antigen (CEA) and cytological analysis, and MFB samples were sent in formalin solution and processed as routine histology specimens as processed.

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Clinical Impact of KRAS and GNAS Analysis Added to CEA and Cytology in Pancreatic Cystic Fluid Obtained by EUS-FNA

Abstract: In this cohort of patients with pancreatic cysts, KRAS and GNAS mutations had no significant diagnostic benefit in comparison with conventional testing.

Cited by 28 publications

References 22 publications

Contrast–enhanced endoscopic ultrasound diagnosis of the intraductal papillary mucinous neoplasm

Contrast–enhanced endoscopic ultrasound diagnosis of the intraductal papillary mucinous neoplasm

Stratifying Intraductal Papillary Mucinous Neoplasms by Cyst Fluid Analysis: Present and Future

Endoscopic Ultrasound‑Guided Diagnosis of Pancreatic Cystic Lesions: Microforceps or Molecular Markers!

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