Adam D Toll1, Thomas Kowalski, David Loren, Marluce Bibbo. 1. Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. adam.toll@jeffersonhospital.org
Abstract
CONTEXT: Recent studies have shown high amplitude K-ras gene mutation and allelic imbalances are predictive of malignancy in pancreatic cysts. OBJECTIVE: Our purpose is to determine the added benefit of molecular testing in diagnosing small pancreatic cysts. DESIGN: Retrospective, single-institution study. PATIENTS: Patients with pancreatic cysts (less than, or equal to, 3 cm) who presented for EUS evaluation. INTERVENTION: EUS-guided pancreatic cyst aspiration cytology, carcinoembryonic antigen (CEA) level determination, and detailed DNA analysis including K-ras gene mutation and allelic imbalance. MAIN OUTCOME MEASUREMENTS: Ability of cyst fluid DNA analysis to render a diagnosis compared with cytology and CEA level determination. RESULTS: Diagnostic agreement was seen in 55.6% (35/63) of cases. In 10 cases (15.9%), there was disagreement between cytology and molecular. Molecular testing provided a diagnosis in 20 cases (31.7%) when either cytology was unsatisfactory, or CEA not elevated (less than 192 ng/mL). Elevated CEA levels were seen in 16 cases (25.4%), each diagnosed as a mucinous lesion with molecular analysis. CONCLUSIONS: Molecular analysis of pancreatic cyst fluid adds diagnostic value in scant specimens when cytology may be unsatisfactory and CEA unreliable.
CONTEXT: Recent studies have shown high amplitude K-ras gene mutation and allelic imbalances are predictive of malignancy in pancreatic cysts. OBJECTIVE: Our purpose is to determine the added benefit of molecular testing in diagnosing small pancreatic cysts. DESIGN: Retrospective, single-institution study. PATIENTS: Patients with pancreatic cysts (less than, or equal to, 3 cm) who presented for EUS evaluation. INTERVENTION: EUS-guided pancreatic cyst aspiration cytology, carcinoembryonic antigen (CEA) level determination, and detailed DNA analysis including K-ras gene mutation and allelic imbalance. MAIN OUTCOME MEASUREMENTS: Ability of cyst fluid DNA analysis to render a diagnosis compared with cytology and CEA level determination. RESULTS: Diagnostic agreement was seen in 55.6% (35/63) of cases. In 10 cases (15.9%), there was disagreement between cytology and molecular. Molecular testing provided a diagnosis in 20 cases (31.7%) when either cytology was unsatisfactory, or CEA not elevated (less than 192 ng/mL). Elevated CEA levels were seen in 16 cases (25.4%), each diagnosed as a mucinous lesion with molecular analysis. CONCLUSIONS: Molecular analysis of pancreatic cyst fluid adds diagnostic value in scant specimens when cytology may be unsatisfactory and CEA unreliable.
Authors: Ajay V Maker; Silvia Carrara; Nigel B Jamieson; Mario Pelaez-Luna; Anne Marie Lennon; Marco Dal Molin; Aldo Scarpa; Luca Frulloni; William R Brugge Journal: J Am Coll Surg Date: 2014-11-06 Impact factor: 6.113
Authors: Eric Ellsworth; Sara A Jackson; Shyam J Thakkar; Dennis M Smith; Sydney Finkelstein Journal: BMC Gastroenterol Date: 2012-12-27 Impact factor: 3.067
Authors: Sydney D Finkelstein; Marluce Bibbo; Thomas E Kowalski; David E Loren; Ali A Siddiqui; Charalambos Solomides; Eric Ellsworth Journal: Diagn Cytopathol Date: 2013-11-22 Impact factor: 1.582
Authors: Nidhi Malhotra; Sara A Jackson; Lindsay L Freed; Mindi A Styn; Mary K Sidawy; Nadim G Haddad; Sydney D Finkelstein Journal: BMC Gastroenterol Date: 2014-08-01 Impact factor: 3.067
Authors: David M Arner; Brooke E Corning; Ali M Ahmed; Henry C Ho; Bradley J Weinbaum; Uzma Siddiqui; Harry Aslanian; Reid B Adams; Todd W Bauer; Andrew Y Wang; Vanessa M Shami; Bryan G Sauer Journal: Endosc Ultrasound Date: 2018 Jan-Feb Impact factor: 5.628