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.
Department of Internal Medicine, Section of Gastroenterology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
Girish
G
Mishra
Yiwen
Y
Zhao
John
J
Sweeney
Benoit C
BC
Pineau
Doug
D
Case
Coty
C
Ho
A William
AW
Blackstock
Kim
K
Geisinger
Russell
R
Howerton
Edward
E
Levine
Perry
P
Shen
Jamal
J
Ibdah
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