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Endosc Int Open 2016; 04(12): E1228-E1235
DOI: 10.1055/s-0042-117216
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic ultrasound-guided fine-needle aspiration plus KRAS and GNAS mutation in malignant intraductal papillary mucinous neoplasm of the pancreas

Barbara Bournet
1   Department of Gastroenterology and INSERM UMR 1037, CHU Toulouse Rangueil, University of Toulouse, Toulouse, France
2   INSERM UMR 1037, University Institute of Cancer of Toulouse, University of Toulouse, Toulouse, France
,
Alix Vignolle-Vidoni
2   INSERM UMR 1037, University Institute of Cancer of Toulouse, University of Toulouse, Toulouse, France
,
David Grand
3   Department of Pathology, University Institute of Cancer of Toulouse, University of Toulouse, Toulouse, France
,
Céline Roques
3   Department of Pathology, University Institute of Cancer of Toulouse, University of Toulouse, Toulouse, France
,
Florence Breibach
3   Department of Pathology, University Institute of Cancer of Toulouse, University of Toulouse, Toulouse, France
,
Jérome Cros
4   Department of Pathology, Beaujon Hospital, University of Paris Diderot, Clichy, France
,
Fabrice Muscari
5   Department of Digestive Surgery, CHU Toulouse Rangueil, University of Toulouse, Toulouse, France
,
Nicolas Carrère
2   INSERM UMR 1037, University Institute of Cancer of Toulouse, University of Toulouse, Toulouse, France
6   Department of Digestive Surgery, CHU Toulouse Purpan, University of Toulouse, Toulouse, France
,
Janick Selves
2   INSERM UMR 1037, University Institute of Cancer of Toulouse, University of Toulouse, Toulouse, France
3   Department of Pathology, University Institute of Cancer of Toulouse, University of Toulouse, Toulouse, France
,
Pierre Cordelier
2   INSERM UMR 1037, University Institute of Cancer of Toulouse, University of Toulouse, Toulouse, France
,
Louis Buscail
1   Department of Gastroenterology and INSERM UMR 1037, CHU Toulouse Rangueil, University of Toulouse, Toulouse, France
2   INSERM UMR 1037, University Institute of Cancer of Toulouse, University of Toulouse, Toulouse, France
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Publikationsverlauf

submitted 20. Februar 2016

accepted after revision 19. August 2016

Publikationsdatum:
10. November 2016 (online)

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Background: KRAS and GNAS mutations are common in intraductal papillary mucinous neoplasia of the pancreas (IPMN). The aims of this study were to assess the role of pre-therapeutic cytopathology combined with KRAS and GNAS mutation assays within cystic fluid sampled by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) to predict malignancy of IPMN.

Patients and methods: We prospectively included 37 IPMN patients with clinical and/or imaging predictors of malignancy (men: 24; mean age: 69.5 years). Cytopathology (performed on cystic fluid and/or IPMN nodules), KRAS (Exon 2, codon 12) and GNAS (Exon 8, codon 201) mutations assays (using TaqMan® allelic discrimination) were performed on EUS-FNA material. The final diagnosis was obtained from IPMN resections (n = 18); surgical biopsies, EUS-FNA analyses, and follow-up (n = 19): 10 and 27 IPMN were benign and malignant, respectively.

Results: Sensitivity, specificity, positive and negative predictive values, and accuracy of cytopathology alone to diagnose IPMN malignancy were 55 %, 100 %, 100 %, 45 %, and 66 %, respectively. When KRAS-mutation analysis was combined with cytopathology these values were 92 %, 50 %, 83 %, 71 %, and 81 %, respectively. GNAS assays did not improve the performances of cytopathology alone or those of cytopathology plus a KRAS assay.

Conclusions: In patients with a likelihood of malignant IPMN at pre-therapeutic investigation, testing for KRAS mutations in cystic fluid sampling by EUS-FNA improved the results of cytopathology for the diagnosis of malignancy whereas GNAS mutation assay did not.

 

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