Factors of Endoscopic Ultrasound-Guided Tissue Acquisition for Successful Next-Generation Sequencing in Pancreatic Ductal Adenocarcinoma

Abstract

Background/Aims: Recent advances in understanding the genetics of pancreatic ductal adenocarcinoma (PDAC) have led to the potential for a personalized approach. Several studies have described the feasibility of generating genetic profiles of PDAC with next-generation sequencing (NGS) of samples obtained through endoscopic ultrasound-guided tissue acquisition (EUS-TA). The aim of this study was to find the best EUS-TA approach for successful NGS of PDAC. Methods: We attempted to perform NGS with tissues from 190 patients with histologically proven PDAC by endoscopic ultrasound-guided fine-needle aspiration and endoscopic ultrasound-guided fine-needle biopsy at Samsung Medical Center between November 2011 and February 2015. The medical records of these patients were retrospectively reviewed for parameters including tumor factors (size, location, and T stage), EUS-TA factors (needle gauge [G], needle type, and number of needle passes) and histologic factors (cellularity and blood contamination). The sample used for NGS was part of the EUS-TA specimen that underwent cytological and histological analysis. Results: NGS could be successfully performed in 109 patients (57.4%). In the univariate analysis, a large needle G (p=0.003) and tumor located in the body/tail (p=0.005) were associated with successful NGS. The multivariate logistic regression analysis revealed that the needle G was an independent factor of successful NGS (odds ratio, 2.19; 95% confidence interval, 1.08 to 4.47; p=0.031). Conclusions: The needle G is an independent factor associated with successful NGS. This finding may suggest that the quantity of cells obtained from EUS-TA specimens is important for successful NGS.

Comparison of endoscopic ultrasound-guided fine-needle biopsy versus fine-needle aspiration for genomic profiling and DNA yield in pancreatic cancer: a randomized crossover trial

“…However, in contrast to the studies by Bang et al [11,25], we were able to determine the specimen adequacy for genomic profiling and yield of DNA by FNB, in addition to the true histology. In addition, it is also known from non-randomized studies that FNB needles are more likely to provide samples adequate for NGS than FNA needles of the same size, and that needle size is an independent factor for NGS success [27,28]. Seventh, we did not investigate how sample adequacy would differ with regard to the type of needle used first.…”

Feasibility of BRCA1/2 Testing of Formalin-Fixed and Paraffin-Embedded Pancreatic Tumor Samples: A Consecutive Clinical Series

“…Although the NGS system allows us to perform extensive molecular analysis on a limited nucleic acid input, the molecular profiling of pancreatic tumor tissues is not yet a part of clinical practice and only few data are available about its feasibility and particularly about BRCA1/2 testing on this type of specimens [22,25]. In 2019, Okuwaki and collaborators evaluated the adequacy of a series of 20 FFPE pancreatic samples obtained by EUS fine-needle aspiration biopsy to evaluate the BRCAness status by multiplex ligationdependent probe amplification (MLPA), reporting a success rate equal to 75% with one positive case [23].…”

“…However, to perform molecular analyses on pancreatic tumor tissues can be challenging, mainly because of the paucity of biological material from traditional fine needle aspirations (FNA) or endoscopic ultrasound (EUS) biopsies in advanced cases [22] and only few data are available about technical aspects related to BRCA1/2 testing on pancreatic formalin-fixed and paraffin-embedded (FFPE) specimens [23].…”

Present and Future of Endoscopic Ultrasound-Guided Tissue Acquisition in Solid Pancreatic Tumors

“…Next-generation sequencing (NGS) has been widely implemented for gene sequencing (Fig. 3) [56]. Recently, several studies have revealed the mutational landscape of pancreatic cancer using NGS.…”