The Added Value of Molecular Testing in Small Pancreatic Cysts
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.
Image: Proposed management algorithm for pancreatic cystic neoplasms.
Downloads
References
Brugge WR, Lauwers GY, Sahani D, Castillo CF, Warshaw AL. Cystic neoplasms of the pancreas. N Engl J Med 2004; 351:1218-26. [PMID 15371579]
Khalid A, Brugge WR. ACG practice guidelines for the diagnosis and management of neoplastic pancreatic cysts. Am J Gastroenterol 2007; 102-2339-49. [PMID 17764489]
Hutchins G, Draganov PV. Diagnostic evaluation of pancreatic cystic malignancies. Surg Clin North Am 2010; 90:399-410. [PMID 20362794]
Brugge WR, Lewandrowski K, Lee-Lewandrowski E, Centeno BA, Szydlo T, Regan S, et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 2004; 126:1330-6. [PMID 15131794]
Federle MP, McGrath KM. Cystic neoplasms of the pancreas. Gastroenterol Clin North Am 2007; 36:365-76. [PMID 17533084]
Khalid A, Zahid M, Finkelstein SD, LeBlanc JK, Kaushik N, Ahmad N, et al. Pancreatic cyst fluid DNA analysis in evaluating pancreatic cysts: a report of the PANDA study. Gastrointest Endosc 2009; 69:1095-102. [PMID 19152896]
Khalid A, McGrath K, Zahid M, Wilson M, Brody D, Swalsky P, et al. The role of pancreatic cyst fluid molecular analysis in predicting cyst pathology. Clin Gastroenterol Hepatol 2005; 3:967-73. [PMID 16234041]
Sawhney MS, Devarajan S, O'Farrel P, Cury MS, Kundu R, Vollmer CM, Brown A, et al. Comparison of carcinoembryonic antigen and molecular analysis in pancreatic cyst fluid. Gastrointest Endosc 2009; 69:1106-10. [PMID 19249035]
Al-Haddad M, Raimondo M, Woodward T, Krishna M, Pungpapong S, Noh K, Wallace MB. Safety and efficacy of cytology brushings versus standard FNA in evaluating cystic lesions of the pancreas: a pilot study. Gastrointest Endosc 2007; 65:894-8. [PMID 17210151]
Schoedel K, Finkelstein S, Ohori N. K-ras and microsatellite marker analysis of fine-needle aspirates from intraductal papillary mucinous neoplasms of the pancreas. Diagn Cytopathol 2006; 34:605-8. [PMID 16900481]
Sreenarasimhaiah J, Lara LF, Jazrawi SF, Barnett CC, Tang SJ. A comparative analysis of pancreatic cyst fluid CEA and histology with DNA mutational analysis in the detection of mucin producing or malignant cysts. JOP. J Pancreas (Online) 2009; 10:163-8. [PMID 19287110]
Shen J, Brugge WR, DiMaio CJ, Pitman MB. Molecular analysis of pancreatic cyst fluid: a comparative analysis with current practice of diagnosis. Cancer Cytopathol 2009; 117:217-27. [PMID 19415731]
Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006; 6:17-32. [PMID 16327281]
Grobmyer SR, Cance WG, Copeland EM, Vogel SB, Hochwald SN. Is there an indication for initial conservative management of pancreatic cystic lesions? J Surg Oncol 2009; 100:372-4. [PMID 19267387]
Goh BK, Tan YM, Chung YF, Chow PK, Cheow PC, Thng CH, et al. Pancreatic cysts: a proposed management algorithm based on current evidence. Am J Surg 2007; 193:749-55. [PMID 17512290]
Allen PJ, D'Angelica M, Gonen M, Jacques DP, Coit DG, Jarnagin WR, DeMatteo R, et al. A selective approach to the resection of cystic lesions of the pancreas: results from 539 consecutive patients. Ann Surg 2006; 244:572-82. [PMID 16998366]
DeWitt J, McGreevy K, Schmidt CM, Brugge WR. EUS-guided ethanol versus saline solution lavage for pancreatic cysts: a randomized, double-blinded study. Gastrointest Endosc 2009; 70:710-23. [PMID 19577745]
Ho KY, Brugge WR, EUS 2008 Working Group. EUS 2008 Working Group document: evaluation of EUS-guided pancreatic-cyst ablation. Gastrointest Endosc 2009; 69(Suppl 2):S22-7. [PMID 19179162]
Copyright (c) 2010 Adam D Toll, Thomas Kowalski, David Loren, Marluce Bibbo
This work is licensed under a Creative Commons Attribution 4.0 International License.
As a member of Publisher International Linking Association, PILA, iMedPub Group’s JOP follows the Creative Commons Attribution License and Scholars Open Access publishing policies. Journal of the Pancreas is the Council Contributor Member of Council of Science Editors (CSE) and following the CSE slogan Education, Ethics, and Evidence for Editors.