title: Endoscopic ultrasound-guided fine-needle aspiration plus KRAS and GNAS mutation in malignant intraductal papillary mucinous neoplasm of the pancreas.
abstract: Background:KRASandGNASmutations are common in intraductal papillary mucinous neoplasia of the pancreas (IPMN). The aims of this study were to assess the role of pre-therapeutic cytopathology combined withKRASandGNASmutation assays within cystic fluid sampled by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) to predict malignancy of IPMN.Patients and methods:We prospectively included 37 IPMN patients with clinical and/or imaging predictors of malignancy (men: 24; mean age: 69.5 years). Cytopathology (performed on cystic fluid and/or IPMN nodules),KRAS(Exon 2, codon 12) andGNAS(Exon 8, codon 201) mutations assays (using TaqMan®allelic discrimination) were performed on EUS-FNA material. The final diagnosis was obtained from IPMN resections (n = 18); surgical biopsies, EUS-FNA analyses, and follow-up (n = 19): 10 and 27 IPMN were benign and malignant, respectively.Results:Sensitivity, specificity, positive and negative predictive values, and accuracy of cytopathology alone to diagnose IPMN malignancy were 55 %, 100 %, 100 %, 45 %, and 66 %, respectively. WhenKRAS-mutation analysis was combined with cytopathology these values were 92 %, 50 %, 83 %, 71 %, and 81 %, respectively.GNASassays did not improve the performances of cytopathology alone or those of cytopathology plus aKRASassay.Conclusions:In patients with a likelihood of malignant IPMN at pre-therapeutic investigation, testing forKRASmutations in cystic fluid sampling by EUS-FNA improved the results of cytopathology for the diagnosis of malignancy whereasGNASmutation assay did not.
authors.affiliation: Department of Gastroenterology and INSERM UMR 1037, CHU Toulouse Rangueil, University of Toulouse, Toulouse, France; INSERM UMR 1037, University Institute of Cancer of Toulouse, University of Toulouse, Toulouse, France.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bournet
authors.affiliation: INSERM UMR 1037, University Institute of Cancer of Toulouse, University of Toulouse, Toulouse, France.
authors.forename: Alix
authors.initials: A
authors.lastname: Vignolle-Vidoni
authors.affiliation: Department of Pathology, University Institute of Cancer of Toulouse, University of Toulouse, Toulouse, France.
authors.forename: David
authors.initials: D
authors.lastname: Grand
authors.affiliation: Department of Pathology, University Institute of Cancer of Toulouse, University of Toulouse, Toulouse, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Roques
authors.affiliation: Department of Pathology, University Institute of Cancer of Toulouse, University of Toulouse, Toulouse, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Breibach
authors.affiliation: Department of Pathology, Beaujon Hospital, University of Paris Diderot, Clichy, France.
authors.forename: Jérome
authors.initials: J
authors.lastname: Cros
authors.affiliation: Department of Digestive Surgery, CHU Toulouse Rangueil, University of Toulouse, Toulouse, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Muscari
authors.affiliation: INSERM UMR 1037, University Institute of Cancer of Toulouse, University of Toulouse, Toulouse, France; Department of Digestive Surgery, CHU Toulouse Purpan, University of Toulouse, Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Carrère
authors.affiliation: INSERM UMR 1037, University Institute of Cancer of Toulouse, University of Toulouse, Toulouse, France; Department of Pathology, University Institute of Cancer of Toulouse, University of Toulouse, Toulouse, France.
authors.forename: Janick
authors.initials: J
authors.lastname: Selves
authors.affiliation: INSERM UMR 1037, University Institute of Cancer of Toulouse, University of Toulouse, Toulouse, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Cordelier
authors.affiliation: Department of Gastroenterology and INSERM UMR 1037, CHU Toulouse Rangueil, University of Toulouse, Toulouse, France; INSERM UMR 1037, University Institute of Cancer of Toulouse, University of Toulouse, Toulouse, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Buscail