title: Telomerase activity in pancreatic juice differentiates pancreatic cancer from chronic pancreatitis: A meta-analysis.
abstract: OBJECTIVE
  To evaluate the usefulness of genetic markers in pancreatic juice (PJ), and the combination of these markers with telomerase activity in the differential diagnosis of pancreatic ductal adenocarcinoma (PDAC) from chronic pancreatitis.
  
  
  METHODS
  We conducted a meta-analysis for the diagnostic utility of the four major altered genes in PDAC (KRAS, CDKN2A/p16, TP53, and SMAD4/DPC4), telomerase activity, and a combination assay using PJ samples. A literature search was conducted in MEDLINE, Cochrane Library, and Web of Science. Data were pooled and presented as diagnostic sensitivity and specificity with 95% confidence intervals (CIs).
  
  
  RESULTS
  Thirty-nine studies fulfilled the inclusion criteria. Pooled estimates of KRAS analysis were as follows: sensitivity was 0.67 (95% CI, 0.63-0.71) and specificity, 0.82 (95% CI, 0.79-0.85). For telomerase activity analysis, sensitivity was 0.82 (95% CI, 0.76-0.87) and specificity, 0.96 (95% CI, 0.90-0.99). The other three tumor suppressors demonstrated low sensitivity. The data did not suggest any publication bias. A combined analysis of KRAS and telomerase activity showed a higher diagnostic sensitivity (0.94; 95% CI, 0.83-0.99) than KRAS alone. A combined analysis of telomerase activity and cytology revealed more reliable diagnostic accuracy than telomerase activity alone, with high sensitivity (0.88; 95% CI, 0.74-0.96) and specificity (1.00; 95% CI, 0.91-1.00).
  
  
  CONCLUSIONS
  The most reliable marker in PJ samples for diagnosis of PDAC was telomerase activity. Telomerase activity can play a central role in diagnostic analysis using PJ samples, and can increase diagnostic accuracy when combined with KRAS mutations or cytological examination.
authors.affiliation: Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Hata
authors.affiliation: Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan. Electronic address: micida33@gmail.com.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Ishida
authors.affiliation: Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Fuyuhiko
authors.initials: F
authors.lastname: Motoi
authors.affiliation: Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Takuhiro
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Naitoh
authors.affiliation: Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan; Division of Integrated Surgery and Oncology, Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Katayose
authors.affiliation: Division of International Cooperation for Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Egawa
authors.affiliation: Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan; Division of Integrated Surgery and Oncology, Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Unno
mesh_terms: D014408:Biomarkers, Tumor / Q000235:genetics / Q000378:metabolism*; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000201:enzymology / Q000235:genetics; D003937:Diagnosis, Differential; D005819:Genetic Markers; D006801:Humans; D010189:Pancreatic Juice / Q000201:enzymology*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000201:enzymology / Q000235:genetics; D050500:Pancreatitis, Chronic / Q000175:diagnosis* / Q000201:enzymology; D012680:Sensitivity and Specificity; D019098:Telomerase / Q000378:metabolism*
chemical_list: D014408:Biomarkers, Tumor; D005819:Genetic Markers; D019098:Telomerase
keywords: Diagnosis; Meta-analysis; Pancreatic cancer; Pancreatic juice; Telomerase