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Gastrointest Endosc. 2009 May;69(6):1095-102. doi: 10.1016/j.gie.2008.07.033. Epub 2009 Jan 18.

Pancreatic cyst fluid DNA analysis in evaluating pancreatic cysts: a report of the PANDA study.

Author information

1
Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, USA. khalida@upmc.edu

Abstract

BACKGROUND:

The role of pancreatic cyst fluid DNA analysis in evaluating pancreatic cysts remains unclear.

OBJECTIVE:

Our purpose was to evaluate the utility of a detailed DNA analysis of pancreatic cyst fluid to diagnose mucinous and malignant cysts.

DESIGN:

Prospective, multicenter study.

PATIENTS:

Patients with pancreatic cysts presenting for EUS evaluation.

INTERVENTION:

EUS-guided pancreatic cyst aspirates cytology evaluation, carcinoembryonic antigen (CEA) level determination, and a detailed DNA analysis; incorporating DNA quantification, k-ras mutation and multiple allelic loss analysis, mutational amplitude, and sequence determination.

MAIN OUTCOME MEASUREMENTS:

Cyst fluid analysis compared with surgical pathologic or malignant cytologic examination.

RESULTS:

The study cohort consisted of 113 patients with 40 malignant, 48 premalignant, and 25 benign cysts. Cyst fluid k-ras mutation was helpful in the diagnosis of mucinous cysts (odds ratio 20.9, specificity 96%), whereas receiver-operator characteristic curve analysis indicated optimal cutoff points for allelic loss amplitude (area under the curve [AUC] 0.79; optimal value > 65%) and CEA (AUC 0.74; optimal value >148 ng/mL). Components of DNA analysis detecting malignant cysts included allelic loss amplitude over 82% (AUC 0.9) and high DNA amount (optical density ratio >10, AUC 0.79). The criteria of a high amplitude k-ras mutation followed by allelic loss showed maximum specificity (96%) for malignancy. All malignant cysts with negative cytologic evaluation (10/40) could be diagnosed as malignant by using DNA analysis.

LIMITATIONS:

Limited follow-up, selection bias.

CONCLUSIONS:

Elevated amounts of pancreatic cyst fluid DNA, high-amplitude mutations, and specific mutation acquisition sequences are indicators of malignancy. The presence of a k-ras mutation is also indicative of a mucinous cyst. DNA analysis should be considered when cyst cytologic examination is negative for malignancy.

Comment in

PMID:
19152896
DOI:
10.1016/j.gie.2008.07.033
[Indexed for MEDLINE]

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