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

doi:10.1016/S0016-5107(04)02224-2

Gastrointestinal Endoscopy

Volume 61, Issue 1, January 2005, Pages 76-79

https://doi.org/10.1016/S0016-5107(04)02224-2 Get rights and content

Background

Despite advances in diagnostic imaging techniques, the differentiation between pancreatic cancer and focal pancreatitis remains difficult. This study evaluated the effectiveness of EUS-guided FNA in the differential diagnosis between pancreatic cancer and focal pancreatitis, with particular reference to detection of the K-ras point mutation.

Methods

The study included 62 consecutive patients with pancreatic ductal cancer and 15 patients with focal pancreatitis demonstrated as a pancreatic mass lesion by EUS.

Results

Sensitivity, specificity, overall accuracy, positive predictive value, and negative predictive value of cytopathologic diagnosis were 82%, 100%, 86%, 100%, and 58%, respectively. Sensitivity, specificity, overall accuracy, positive predictive value, and negative predictive value of histopathologic diagnosis were 44%, 100%, 55%, 100%, and 32%, respectively. The K-ras point mutation was found in 74% of pancreatic cancers and 0% of focal pancreatitis lesions. No complication of EUS-guided FNA was observed.

Conclusions

EUS-guided FNA is useful for the differential diagnosis of pancreatic mass lesions caused by pancreatic cancer and focal pancreatitis. Analysis for the K-ras point mutation in specimens obtained by EUS-guided FNA may enhance diagnostic accuracy in indeterminate cases.

Section snippets

Patients and methods

The study included 62 patients with a diagnosis of pancreatic ductal cancer and 15 patients with focal pancreatitis (total 77 patients) who underwent EUS-FNA between August 1998 and April 2003 for whom the results of cytopathologic and histopathologic evaluation, and K-ras point mutation analysis could be obtained. Final diagnoses were confirmed by evaluation of surgical resection specimens in 8 patients (pancreatic cancer 6, focal pancreatitis 2) and by clinical follow-up of 9 months or longer

Results

There was no significant difference between the patient groups with respect to age, gender, number of needle passes, and location or size of the mass (Table 1).

Discussion

Compared with the rest of the GI tract, a nonoperative biopsy specimen of the pancreas is difficult to obtain. Nevertheless, there have been many studies of methods for obtaining a histopathologic or a cytopathologic diagnosis, including US- and CT-guided percutaneous biopsy, transpapillary pancreatic duct biopsy, and cytologic evaluation of pancreatic juice obtained at ERCP.1, 5, 15 With the development of EUS-FNA, however, the ability to accurately diagnose pancreatic malignancy has greatly

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Cited by (132)

K-ras gene mutation analysis to diagnosis pancreatic adenocarcinoma from endoscopic ultrasound-guided tissue acquisition; a systematic review and meta-analysis
2024, Pancreatology
Endoscopic ultrasound-guided tissue acquisition (EUS-TA) has high sensitivity for the pathological diagnosis of pancreatic masses, but also a high false-negative rate. K-ras gene mutations occur in over 75 % of pancreatic ductal adenocarcinomas (PDAC), and this meta-analysis evaluated the utility of detecting K-ras gene mutations from EUS-TA specimens for the diagnosis of PDAC.
Relevant studies in PubMed, the Cochrane Library, and Web of Science were systematically searched. Meta-analysis was performed on data from the selected studies using a bivariate model to provide pooled values of sensitivity, specificity, and their 95 % confidence intervals (CIs).
This meta-analysis included 1521 patients (from 10 eligible studies) who underwent EUS-TA with K-ras gene mutation analysis for diagnosis of pancreatic solid masses. The pooled estimates of sensitivity and specificity were 76.6 % (95 % CI, 70.9–81.5 %) and 97.0 % (95 % CI, 94.0–98.5 %), respectively, for pathological diagnosis, 75.9 % (95 % CI 69.5–81.4 %) and 95.3 % (95 % CI, 92.3–97.2 %) for K-ras gene mutation analysis, and 88.7 % (95 % CI 87.1–91.7 %) and 94.9 % (95 % CI, 91.5–97.0 %) for pathological diagnosis in combination with K-ras gene mutation analysis. The sensitivity for diagnosis of PDAC was significantly higher for pathological diagnosis in combination with K-ras gene mutation analysis than for pathological diagnosis or K-ras gene mutation analysis alone (both, p < 0.001). There was no difference in specificity between pathological diagnosis in combination with K-ras gene mutation analysis and both either (p = 0.234, 0.945, respectively).
K-ras gene mutation analysis in combination with to pathological diagnosis of EUS-TA increases the accuracy of differential diagnosis of PDAC.
Endoscopic Ultrasonography with Fine-needle Aspiration: New Techniques for Interpretation of Endoscopic Ultrasonography Cytology and Histology Specimens
2017, Gastrointestinal Endoscopy Clinics of North America
Targeting KRAS for diagnosis, prognosis, and treatment of pancreatic cancer: Hopes and realities
2016, European Journal of Cancer
Citation Excerpt :
Several research groups, including ours, have demonstrated that KRAS mutations can be detected in cellular materials obtained by EUS-FNA. KRAS mutation analysis after EUS-FNA appears to be highly accurate at differentiating benign versus malignant pancreatic solid lesions. [34,35,39–47] All these studies are summarised in Table 1.
Mutation of the KRAS oncogene in pancreatic cancer is responsible for permanent activation of the P21 RAS protein and the cascade of signalling pathways. Consequently, multiple cellular processes, such as transformation, proliferation, invasion, and survival are activated. The aim of this review was to present all potential clinical applications of targeting KRAS in terms of diagnosis and management of pancreatic adenocarcinoma. Quantitative polymerase chain reaction technology provides reliable assessment of KRAS mutations, both in tissues and from fine-needle aspiration biopsies. Numerous studies report that the combination of endoscopic ultrasound-guided cytopathology and a KRAS mutation assay can improve the positive and differential diagnosis of pancreatic cancer, differentiating between benign versus malignant solid pancreatic cancer, and reducing false-negative results compared to cytopathology alone. In addition, the presence of a KRAS mutation is frequently associated with a worse prognosis, both in cases of advanced and resected tumours. However, the KRAS mutation assay is not as efficient at predicting a response to both anti-epidermal growth factor receptor treatments and/or chemotherapy. Targeting of KRAS to treat pancreatic adenocarcinoma has been applied at different stages of RAS molecular intracellular processes: at the transcription level with antisense or interference RNA, at the posttranslational level with inhibitors of farnesyl transferase or anti-RAS vaccination peptides, and to target multiple signalling pathways using inhibitors of mitogen-activated protein kinase, phosphoinositide 3-kinase, AKT, mammalian target of rapamycin, RAF. Despite some encouraging results at pre-clinical and phase I stages, no significant clinical benefits have been observed. Combinatory approaches with standard chemotherapy will be welcome.
Droplet digital polymerase chain reaction detection of KRAS mutations in pancreatic FNA samples: Technical and practical aspects for routine clinical implementation
2024, Cancer Cytopathology
Approach to Pancreatic Head Mass in the Background of Chronic Pancreatitis
2023, Diagnostics
Endoscopic Ultrasound for Diagnosis of Chronic Pancreatitis Versus Pancreatic Cancer
2023, The Pancreas: an Integrated Textbook of Basic Science, Medicine, and Surgery, Fourth Edition

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Gastrointestinal Endoscopy

Background

Methods

Results

Conclusions

Section snippets

Patients and methods

Results

Discussion

References (19)

Endosonography-guided fine needle aspiration biopsy in the evaluation of pancreatic mass

Am J Gastroenterol

Value of helical computed tomography, angiography, and endoscopic ultrasound in determining resectability of periampullary carcinoma

Am J Surg

Diagnostic utility of K-ras mutations in fine-needle aspirates of pancreatic masses

Gastroenterology

Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment

Gastroenterology

The clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of pancreatic carcinoma

Gastrointest Endosc

EUS and K-ras analysis of pure pancreatic juice collected via a duodenoscope after secretin stimulation for diagnosis of pancreatic mass lesion: a prospective study

Gastrointest Endosc

Pancreatic tissue sampling guided by EUS, CT/US, and surgery: a comparison of sensitivity and specificity

Gastrointest Endosc

Clinical application of ras gene mutation for diagnosis of pancreatic adenocarcinoma

Gastroenterology

Pancreatic tumors: evaluation with endoscopic US, CT, and MR imaging

Radiology

Cited by (132)

K-ras gene mutation analysis to diagnosis pancreatic adenocarcinoma from endoscopic ultrasound-guided tissue acquisition; a systematic review and meta-analysis

Endoscopic Ultrasonography with Fine-needle Aspiration: New Techniques for Interpretation of Endoscopic Ultrasonography Cytology and Histology Specimens

Targeting KRAS for diagnosis, prognosis, and treatment of pancreatic cancer: Hopes and realities

Droplet digital polymerase chain reaction detection of KRAS mutations in pancreatic FNA samples: Technical and practical aspects for routine clinical implementation

Approach to Pancreatic Head Mass in the Background of Chronic Pancreatitis

Endoscopic Ultrasound for Diagnosis of Chronic Pancreatitis Versus Pancreatic Cancer

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

Background

Methods

Results

Conclusions

Section snippets

Patients and methods

Results

Discussion

Am J Gastroenterol

Am J Surg

Gastroenterology

Gastroenterology

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastroenterology

Pancreatic tumors: evaluation with endoscopic US, CT, and MR imaging

Radiology

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