Determination of qualitative telomerase activity as an adjunct to the diagnosis of pancreatic adenocarcinoma by EUS-guided fine-needle aspiration.
BACKGROUND
Telomerase activity is up-regulated in pancreatic cancer. Hence, measurement of telomerase activity in pancreatic needle-biopsy specimens could assist in establishing a positive diagnosis in specimens that are inadequate for cytology.


OBJECTIVE
To determine the sensitivity and specificity of telomerase activity for neoplasia in a series of EUS-guided fine-needle aspirate (EUS-FNA) biopsies of pancreatic mass lesions.


METHODS
Prospective, consecutive, non-randomized cohort.


METHODS
Academic hospital, tertiary referral center.


METHODS
Seventy-one patients with a pancreatic mass diagnosed by cross-sectional imaging.


METHODS
EUS-FNA of 52 solid and 18 cystic pancreatic lesions.


METHODS
(1) Cytologic diagnosis; (2) tissue telomerase activity by semi-quantitative polymerase chain reaction; (3) patient demographics; (4) clinical outcomes.


RESULTS
Cytology results were positive for adenocarcinoma in 40 patients with a solid pancreatic mass; of these, telomerase activity was detected in 31. There were no telomerase false-positive results. Telomerase results were positive in 6 of the 7 patients (86%) who had negative cytology results and who eventually were found to have biopsy-proven adenocarcinoma. The sensitivity and specificity of telomerase activity for detecting pancreatic adenocarcinoma in solid masses was 79% (95% CI, 64%-89%) and 100% (95% CI, 55%-100%).


CONCLUSIONS
Extremely high sensitivity and specificity of EUS-FNA cytology in solid lesions minimized the incremental benefit of telomerase.


CONCLUSIONS
Telomerase activity can be measured readily in specimens obtained at EUS-FNA and accurately predicts malignancy. Used in combination with cytology, telomerase increased the sensitivity from 85% to 98% while maintaining the specificity at 100%. Lesions with negative cytology result and positive telomerase activity should be evaluated aggressively to exclude malignancy.
Mishra
Girish
G
Department of Internal Medicine, Section of Gastroenterology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
Zhao
Yiwen
Y
Sweeney
John
J
Pineau
Benoit C
BC
Case
Doug
D
Ho
Coty
C
Blackstock
A William
AW
Geisinger
Kim
K
Howerton
Russell
R
Levine
Edward
E
Shen
Perry
P
Ibdah
Jamal
J
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000201:enzymology* / Q000473:pathology; D014408:Biomarkers, Tumor; D044963:Biopsy, Fine-Needle / Q000379:methods; D004273:DNA, Neoplasm / Q000235:genetics*; D003937:Diagnosis, Differential; D019160:Endosonography; D005500:Follow-Up Studies; D006801:Humans; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000201:enzymology* / Q000473:pathology; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D019098:Telomerase / Q000235:genetics / Q000378:metabolism*
D014408:Biomarkers, Tumor; D004273:DNA, Neoplasm; D019098:Telomerase