DNA mutational differences in cytological specimens from pancreatic cancer and cholangiocarcinoma.
OBJECTIVE
Preoperative distinction between pancreatic cancer (PC) and extrahepatic cholangiocarcinoma (CC) is desirable due to diverging management options, and to optimize enrollment into neoadjuvant trials.


METHODS
A single-center retrospective study of patients with PC or CC was undertaken. Four blinded pathologists reviewed all cases and reached a consensus diagnosis (PC or CC). Microdissection-based multiple microsatellite loss analysis and direct sequencing of K-ras oncogene was performed and compared for PC and CC.


RESULTS
Of 33 cases studied (17 males; 16 PC, 17 CC; 10 with primary sclerosing cholangitis), a K-ras mutation was present in 14/16 (87.5%) PC and 1/17 (5.9%) CC cases (p < 0.001), sensitivity and specificity were 87.5 and 94%, respectively. The mean fractional mutational rate was higher in PC (0.51; 95% CI 0.45-0.58) compared to CC (0.34; 95% CI 0.28-0.39, p < 0.001).


CONCLUSIONS
The presence of a K-ras mutation in cytology specimens distinguishes PC from CC in this study. and IAP.
Fasanella
Kenneth E
KE
Department of Medicine, The University of Pittsburgh Medical Center, Pittsburgh, Pa, USA.
Krasinskas
Alyssa
A
Schoedel
Karen E
KE
Sasatomi
Eizaburo
E
Slivka
Adam
A
Whitcomb
David C
DC
Sanders
Michael
M
Nodit
Laurentia
L
Raab
Stephen
S
McGrath
Kevin M
KM
Ohori
N Paul
NP
Khalid
Asif
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000235:genetics*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000235:genetics*; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000235:genetics*; D015209:Cholangitis, Sclerosing / Q000235:genetics / Q000473:pathology; D004252:DNA Mutational Analysis; D004273:DNA, Neoplasm / Q000032:analysis; D005260:Female; D011905:Genes, ras / Q000235:genetics; D006801:Humans; D008297:Male; D042282:Microdissection; D053842:Microsatellite Instability; D008875:Middle Aged; D009154:Mutation; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000235:genetics*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D004273:DNA, Neoplasm