title: Performance characteristics of molecular (DNA) analysis for the diagnosis of mucinous pancreatic cysts.
abstract: BACKGROUND
  Diagnosis of mucinous pancreatic cysts (MPCs) is challenging due to the poor sensitivity of cytology provided by EUS-guided-FNA (EUS-FNA).
  
  
  OBJECTIVE
  To quantify the test characteristics of molecular (DNA) analysis in suspected low-risk MPCs.
  
  
  METHODS
  A prospective cohort study performed in between 2008 and 2011.
  
  
  METHODS
  Academic referral center.
  
  
  METHODS
  Consecutive patients who underwent EUS-FNA of suspected MPCs.
  
  
  METHODS
  EUS-FNA and molecular (DNA) analysis of cyst fluid.
  
  
  METHODS
  The sensitivity and specificity of molecular analysis in the diagnosis of MPCs using the criterion standard of surgical pathology in resected cysts.
  
  
  RESULTS
  Patients with suspected MPCs underwent EUS-FNA and cyst fluid DNA analysis. Surgical resection was performed in 48 patients (17%), confirming a mucinous pathology in 38 (79%). In this group, molecular analysis had a sensitivity of 50% and a specificity of 80% in identifying MPCs (accuracy of 56.3%). The combination of molecular analysis with cyst fluid carcinoembryonic antigen (CEA) and cytology resulted in higher MPC diagnostic performance than either one of its individual components, with a sensitivity, specificity, and accuracy of 73.7%, 70%, and 72.9%, respectively. There was no significant difference in accuracy between molecular analysis and CEA/cytology in this group.
  
  
  CONCLUSIONS
  Single-center experience.
  
  
  CONCLUSIONS
  Molecular analysis aids in the diagnosis of MPCs when cytology is nondiagnostic or cyst fluid is insufficient for CEA or its level is indeterminate. Our results do not support the routine use of molecular analysis, which should be used selectively after review of imaging findings and cyst fluid studies. Further studies are needed to assess DNA's performance in malignant cysts.
authors.affiliation: Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Al-Haddad
authors.affiliation: Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: John
authors.initials: J
authors.lastname: DeWitt
authors.affiliation: Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: C Max
authors.initials: CM
authors.lastname: Schmidt
authors.affiliation: Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Julia K
authors.initials: JK
authors.lastname: LeBlanc
authors.affiliation: Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: McHenry
authors.affiliation: Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Coté
authors.affiliation: Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Abdul Hamid
authors.initials: AH
authors.lastname: El Chafic
authors.affiliation: Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Leticia
authors.initials: L
authors.lastname: Luz
authors.affiliation: Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Jennifer Schaffter
authors.initials: JS
authors.lastname: Stuart
authors.affiliation: Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Johnson
authors.affiliation: Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Christen
authors.initials: C
authors.lastname: Klochan
authors.affiliation: Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Imperiale
mesh_terms: D000230:Adenocarcinoma / Q000235:genetics / Q000473:pathology; D000368:Aged; D002272:Carcinoembryonic Antigen / Q000032:analysis; D020420:Cyst Fluid / Q000737:chemistry*; D004247:DNA / Q000032:analysis*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D011905:Genes, ras; D006801:Humans; D019656:Loss of Heterozygosity; D008297:Male; D008875:Middle Aged; D009154:Mutation; D018358:Neuroendocrine Tumors / Q000235:genetics / Q000473:pathology; D010181:Pancreatic Cyst / Q000235:genetics* / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000235:genetics* / Q000473:pathology*; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D002272:Carcinoembryonic Antigen; D004247:DNA
keywords: CCD; CEA; EUS-FNA; EUS-guided FNA; HGD; IPMN; LGD; LOH; MCN; MPC; carcinoembryonic antigen; carcinoembryonic antigen/cytology diagnosis; high-grade dysplasia; intraductal papillary mucinous neoplasm; loss of heterozygosity; low-grade dysplasia; mucinous cystic neoplasm; mucinous pancreatic cyst