Low sensitivity of the ki-ras polymerase chain reaction for diagnosing pancreatic cancer from pancreatic juice and bile: a multicenter prospective trial.
OBJECTIVE
Early detection of pancreatic cancer using molecular markers may improve outcome. Mutations of the ki-ras oncogene are detected in 70% to 90% of pancreatic adenocarcinomas. A prospective, partially blinded, multicenter diagnostic trial was performed to test the sensitivity and specificity of the ki-ras polymerase chain reaction (PCR) analysis of pancreatic juice and bile specimens.


METHODS
Specimens of pancreatic juice and bile were collected from 532 consecutive patients. Mutations in codon 12 of the ki-ras gene were identified by two independent enrichment PCRs and confirmed by direct sequencing.


RESULTS
One hundred seventy-four of 532 patients were excluded from the final analysis (reasons: no amplifiable DNA, no specimen or only duodenal juice sent, lost to follow-up). Sixty-three of 358 patients had ductal pancreatic cancer. In 24 (38.1%) of 63 patients, a mutated ki-ras gene was identified in pancreatic juice and/or bile. Ki-ras mutations were found in four (8%) of 50 cases of chronic pancreatitis, in 10 (18.7%) of 53 cases of other malignancies of the pancreaticobiliary tree, and in 14 (7.3%) of 192 cases of benign diseases or normal findings. Sensitivity and specificity of the ki-ras PCR analysis for the detection of pancreatic cancer was 38.1% and 90.5%, respectively.


CONCLUSIONS
In this prospective trial performed in nonselected patients, mutations of the ki-ras gene were detected in 38.1% of cases with pancreatic cancer. This test in its present form is not appropriate to confirm or screen for pancreatic cancer. More sensitive and/or quantitative PCR tests may improve the molecular diagnosis of pancreatic cancer.
Trümper
Lorenz
L
Department of Internal Medicine I and Department of Internal Medicine II, University of the Saarland, Homburg. lorenz.truemper@med.uni-goettingen.de
Menges
Markus
M
Daus
Heiner
H
Köhler
Daniel
D
Reinhard
Jan-Olaf
JO
Sackmann
Michael
M
Moser
Cornelius
C
Sek
Alexandra
A
Jacobs
Georg
G
Zeitz
Martin
M
Pfreundschuh
Michael
M
D000328:Adult; D000368:Aged; D001646:Bile / Q000737:chemistry; D004252:DNA Mutational Analysis; D003937:Diagnosis, Differential; D005260:Female; D011905:Genes, ras / Q000235:genetics*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010189:Pancreatic Juice / Q000737:chemistry; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000235:genetics*; D016133:Polymerase Chain Reaction / Q000592:standards*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016037:Single-Blind Method