Differential diagnosis of pancreatic cancer and focal pancreatitis by using EUS-guided FNA

Takahashi, Kuniyuki; Yamao, Kenji; Okubo, Kenji; Sawaki, Akira; Mizuno, Nobumasa; Ashida, Reiko; Koshikawa, Takashi; Ueyama, Yuji; Kasugai, Kunio; Hase, Satoshi; Kakumu, Shinichi

doi:10.1016/s0016-5107(04)02224-2

Cited by 116 publications

(90 citation statements)

References 19 publications

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“…La spécifi-cité est assez élevée (entre 90 et 100 %), ce qui permet d'assurer le diagnostic de bénignité des masses pancréatiques. Plusieurs études, incluant celle menée par notre équipe, ont évalué l'importance de la recherche de la mutation de Kras dans le matériel de cytoponction pancréatique pour le diagnostic d'adénocarcinome (Tableau II) [20,[23][24][25][26]. Cette analyse apporte, tout d'abord, une contribution au diagnostic différentiel entre cancer et pancréatite chronique pseudotumorale.…”

Section: éTudes Sur Le Matériel De Ponction Pancréatiqueunclassified

OncogèneKraset cancer du pancréas

et al. 2013

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> La mutation ponctuelle de l'oncogène Kras confère un gain de prolifération non contrôlée pour la cellule cancéreuse qui acquiert ainsi un pouvoir oncogénique amplifié. Cette mutation est retrouvée dans 75 à 95 % des cancers du pancréas, mais aussi dans les lésions précancéreuses de type PanIN (pancreatic intraepithelial neoplasia) ou TIPMP (tumeur intracanalaire papillaire mucineuse du pancréas). Ces lésions, ainsi que le microenvironnement tumoral, ont été reproduits dans des modèles transgéniques établis chez la souris à partir de la mutation de Kras (souris Pdx1 [pancreatic and duodenal homeobox 1]-Cre ; Kras G12D ) associée ou non à l'inactivation de gènes suppresseurs de tumeurs (TP53, DPC4, INK4A). La recherche de la mutation de Kras en clinique humaine est facile et fiable à partir des milieux biologiques, en particulier sur le matériel de cytoponction de masses pancréatiques prélevé sous écho-endoscopie. Cette recherche devrait être utile dans un avenir proche pour l'aide au diagnostic positif de cancer, en cas de d'examen cytopathologique douteux ou non contributif, mais aussi pour le diagnostic différentiel avec la pancréatite chronique dans sa forme pseudotumorale. < famille Ras, Hras, Nras et Kras (H pour Harvey, N pour neuroblastoma, et K pour Kirsten), codent pour une protéine de 21 kDa impliquée dans la transduction des signaux prolifératifs des facteurs de croissance. Les protéines p21-Ras assurent leur fonction de transduction en se liant au GTP. La régulation fine du degré d'activation de p21-Ras se trouve déstabilisée lorsqu'il existe une mutation au niveau du site de liaison du GTP. La conséquence fonctionnelle de cette mutation est une suractivation des signaux prolifératifs transmise en cascade aux protéines de la transduction situées en aval de p21-Ras (sérine et thréonine kinases). Parmi les cancers épithéliaux, l'adénocarcinome pancréatique est celui qui présente le plus fréquemment une mutation de l'oncogène Kras, participant au gain de prolifération et d'invasion pour ce cancer de mauvais pronostic et difficile à traiter [1, 2]. Plus de 30 ans après la découverte de Kras, le but de cette revue est de rapporter l'intérêt de l'étude de cet oncogène dans le cancer du pancréas, tant au plan scientifique que médical. Nous aborderons plus particulièrement la pathologie expérimentale et l'implication possible dans le diagnostic du cancer du pancréas. Rôle et conséquences de l'activation du gène RasLe gène Kras se situe sur le chromosome 12 (12pl2). La protéine p21-Ras est cytosolique et son ancrage à la face interne de la membrane cytoplasmique par son extrémité carboxy-terminale est nécessaire pour son activation [2]. Elle présente des homologies de structure avec la sous-unité  des protéines G. L'activation de la protéine Ras se fait en plusieurs étapes successives au cours desquelles Ras subira des modifications post-traductionnelles au niveau du domaine CAAX de sa région

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Section: éTudes Sur Le Matériel De Ponction Pancréatiqueunclassified

OncogèneKraset cancer du pancréas

et al. 2013

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“…[7][8][9] Although the accuracy of EUS-FNA for detection of PDAC is relatively high due to the improvement of endoscopes and on site cytological assessment, there is still a relatively large number of cases in which the diagnosis remains problematic due to sample inadequacy, nondefinitive (suspicious) diagnosis or discordance in pathological interpretation. 7,10,11 Difficulties in morphological differentiation of CP and PDAC are attributed to extensive fibrosis that is ultimately caused by a variety of genetic alterations, many of which are common between both disease states. [12][13][14][15][16][17] Recent developments using various molecular detection technologies including serial analysis of gene expression, cDNA microarrays, tissue arrays and the human genome-sequencing project has led to the discovery of multiple genes that are overexpressed in CP and PDAC.…”

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confidence: 99%

Accurate discrimination of pancreatic ductal adenocarcinoma and chronic pancreatitis using multimarker expression data and samples obtained by minimally invasive fine needle aspiration

Chen

Zheng

Robbins

et al. 2007

Intl Journal of Cancer

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To augment cytological diagnosis of pancreatic ductal adenocarcinoma (PDAC) in tissue samples obtained by minimally invasive endoscopic ultrasound-guided fine needle aspiration, we investigated whether a small set of molecular markers could accurately distinguish PDAC from chronic pancreatitis (CP). Expression levels of 29 genes were first determined by quantitative real-time RT-PCR in a training set of tissues in which the final diagnosis was PDAC (n 5 20) or CP (n 5 10). Using receiver operator characteristic curve analysis, we determined that the single gene with the highest diagnostic accuracy for discrimination of CP vs. PDAC in the training study was urokinase plasminogen activator receptor (UPAR; AUC value 5 0.895, 95% CI 5 0.728-0.976). In the set of test tissues (n 5 14), the accuracy of UPAR decreased to 79%. However, we observed that the addition of 6 genes (EPCAM2, MAL2, CEA5, CEA6, MSLN and TRIM29; referred to as the 6-gene classifier) to UPAR resulted in high accuracy in both training and testing sets. Excluding 3 samples (out of 44; 7%) for which results of the UPAR/6-gene classifier were ''undefined,'' the accuracy of the UPAR/6-gene classifier was 100% in training samples (n 5 29), 92% in 12 test samples (p 5 0.004 that results were randomly generated; p 5 0.046 that the UPAR/6-gene classifier was comparable to UPAR alone; v 2 test), 100% in 3 samples for which the initial cytological diagnosis was ''suspicious'' and 98% (40/41) overall. Our results provide evidence that molecular marker expression data can be used to augment cytological analysis. ' 2006 Wiley-Liss, Inc.Key words: chronic pancreatitis; pancreatic ductal adenocarcinoma; urokinase plasminogen activator receptor; diagnostic accuracy Although the incidence of pancreatic ductal adenocarcinoma (PDAC) is only 1-2% and relatively low compared to other cancers, nearly all patients die from PDAC within 1-2 years.

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“…Takahashi et al reported that K-ras point mutations were found in 74% of pancreatic cancers and 0% of focal pancreatitis lesions [44]. They also mentioned that analysis for the K-ras point mutation in specimens obtained by EUS-guided FNA might enhance diagnostic accuracy in indeterminate cases.…”

Section: Reviewmentioning

confidence: 99%

EUS – Fine- Needle Aspiration Biopsy (FNAB) in the Diagnosis of Pancreatic Adenocarcinoma: A Review

Kalogeraki

Papadakis

Tamiolakis

et al. 2016

Romanian Journal of Internal Medicine

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Solid masses of the pancreas represent a variety of benign and malignant neoplasms of the exocrine and endocrine tissues of the pancreas. A tissue diagnosis is often required to direct therapy in the face of uncertain diagnosis or if the patient is not a surgical candidate either due to advanced disease or comorbidities. Endoscopic ultrasound (EUS) is a relatively new technology that employs endoscopy and high-frequency ultrasound (US). EUS involves imaging of the pancreatic head and the uncinate from the duodenum and imaging of the body and tail from the stomach. It has been shown to be a highly sensitive method for the detection of pancreatic masses. It is superior to extracorporeal US and computed tomographic (CT) scans, especially when the pancreatic tumor is smaller than 2-3 cm. Although EUS is highly sensitive in detecting pancreatic solid masses, its ability to differentiate between inflammatory masses and malignant disease is limited. Endoscopic retrograde cholangiopancreatography (ERCP) brushing, CT-guided biopsies, and transabdominal ultrasound (US) have been the standard nonsurgical methods for obtaining a tissue diagnosis of pancreatic lesions, but a substantial false-negative rate has been reported. Transabdominal US-guided fine-needle aspiration biopsy (US-FNAB) has been used for tissue diagnosis in patients with suspected pancreatic carcinoma. It has been shown to be highly specific, with no false-positive diagnoses. With the advent of curvilinear echoendoscopes, transgastric and transduodenal EUS-FNAB of the pancreas have become a reality EUS with FNAB has revolutionized the ability to diagnose and stage cancers of the gastrointestinal tract and assess the pancreas. Gastrointestinal cancers can be looked at with EUS and their depth of penetration into the intestinal wall can be determined. Any suspicious appearing lymph nodes can be biopsied using EUS/FNAB. The pancreas is another organ that is well visualized with EUS. Abnormalities such as tumors and cysts of the pancreas can be carefully evaluated using EUS and then biopsied with FNAB. There are many new applications of EUS using FNAB. Researchers are looking to deliver chemotherapeutics into small pancreatic cancers and cysts. Nerve blocks using EUS/FNAB to inject numbing medicines into the celiac ganglia, a major nerve cluster, are now routinely performed in patients with pain due to pancreatic cancer. The aim of this study is to perform a review of the literature regarding the usefulness of EUS/FNAB in the diagnosis of pancreatic adenocarcinoma.

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Differential diagnosis of pancreatic cancer and focal pancreatitis by using EUS-guided FNA

Cited by 116 publications

References 19 publications

OncogèneKraset cancer du pancréas

OncogèneKraset cancer du pancréas

Accurate discrimination of pancreatic ductal adenocarcinoma and chronic pancreatitis using multimarker expression data and samples obtained by minimally invasive fine needle aspiration

EUS – Fine- Needle Aspiration Biopsy (FNAB) in the Diagnosis of Pancreatic Adenocarcinoma: A Review

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