title: Team work and cytopathology molecular diagnosis of solid pancreatic lesions.
abstract: Pancreatic ductal adenocarcinoma (PDAC) is expected to become the second leading cause of cancer-associated death in the next decade or so. It is widely accepted that tumorigenesis is linked to specific alterations in key genes and pancreatic neoplasms are some of the best characterized at the genomic level. Recent whole-exome and whole-genome sequencing analyses confirmed that PDAC is frequently characterized by mutations in a set of four genes among others: KRAS, TP53, CDKN2A/p16, and SMAD4. Sequencing, for example, is the preferable technique available for detecting KRAS mutations, whereas in situ immunochemistry is the main approach for detecting TP53 gene alteration. Nevertheless, the diagnosis of PDAC is still a clinical challenge, involving adequate acquisition of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) and specific pathological assessment from tissue architecture to specific biomolecular tests. The aim of the present review is to provide a complete overview of the current knowledge of the biology of pancreatic cancer as detected by the latest biomolecular techniques and, moreover, to propose a paradigm for strict teamwork collaboration in order to improve the correct use of diagnostic sources.
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Fabbri
authors.affiliation: Medical Pathology, Department of Internal Medicine, Gastroenterology Division, Policlinico Universitario A. Gemelli, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Gibiino
authors.affiliation: Anatomic Pathology Unit, AUSL of Bologna, Maggiore Hospital, Italy.
authors.forename: Adele
authors.initials: A
authors.lastname: Fornelli
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cennamo
authors.affiliation: Department of Pharmacy and Biotechnology (FaBiT), University of Bologna, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Grifoni
authors.affiliation: Department of Medicine (DIMES), Molecular Diagnostic Unit AUSL of Bologna, University of Bologna School of Medicine, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Visani
authors.affiliation: Department of Medicine (DIMES), Molecular Diagnostic Unit AUSL of Bologna, University of Bologna School of Medicine, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Acquaviva
authors.affiliation: Department of Medicine, Anatomic Pathology, University of Padua, Padova, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Fassan
authors.affiliation: Internal Medicine Unit, Maggiore Hospital, Bologna, Italy.
authors.forename: Sirio
authors.initials: S
authors.lastname: Fiorino
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Giovanelli
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bassi
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Ghersi
authors.affiliation: Department of Medicine (DIMES), Molecular Diagnostic Unit AUSL of Bologna, University of Bologna School of Medicine, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tallini
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Italy.
authors.forename: Elio
authors.initials: E
authors.lastname: Jovine
authors.affiliation: Medical Pathology, Department of Internal Medicine, Gastroenterology Division, Policlinico Universitario A. Gemelli, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
authors.affiliation: Department of Pharmacy and Biotechnology (FaBiT), University of Bologna, Italy.
authors.forename: Dario
authors.identifier: http://orcid.org/0000-0002-0609-8817
authors.initials: D
authors.lastname: de Biase
mesh_terms: D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging / Q000235:genetics* / Q000473:pathology*; D019941:Cyclin-Dependent Kinase Inhibitor p16; D050763:Cyclin-Dependent Kinase Inhibitor p18 / Q000235:genetics; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D025202:Molecular Diagnostic Techniques; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000235:genetics* / Q000473:pathology*; D010348:Patient Care Team / Q000458:organization & administration; D012680:Sensitivity and Specificity; D051901:Smad4 Protein / Q000235:genetics
chemical_list: C000614131:CDKN2A protein, human; D019941:Cyclin-Dependent Kinase Inhibitor p16; D050763:Cyclin-Dependent Kinase Inhibitor p18; C497796:SMAD4 protein, human; D051901:Smad4 Protein
keywords: endoscopic ultrasound-guided fine-needle aspiration; molecular diagnostic; molecular markers; pancreatic ductal adenocarcinoma; review