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Gastrointest Endosc. 2013 Oct;78(4):596-608. doi: 10.1016/j.gie.2013.04.162. Epub 2013 May 6.

The role of K-ras gene mutation analysis in EUS-guided FNA cytology specimens for the differential diagnosis of pancreatic solid masses: a meta-analysis of prospective studies.

Author information

1
Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.

Abstract

BACKGROUND:

Differential diagnosis of pancreatic solid masses with EUS-guided FNA (EUS-FNA) is still challenging in about 15% of cases. Mutation of the K-ras gene is present in over 75% of pancreatic adenocarcinomas (PADC).

OBJECTIVE:

To assess the accuracy of K-ras gene mutation analysis for diagnosing PADC.

DESIGN:

We systematically searched the electronic databases for relevant studies published. Data from selected studies underwent meta-analysis by use of a bivariate model providing a pooled value for sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curve.

SETTING:

Meta-analysis of 8 prospective studies.

PATIENTS:

Total of 931 patients undergoing EUS-FNA for diagnosis of pancreatic solid masses.

INTERVENTION:

K-ras mutation analysis.

MAIN OUTCOME MEASUREMENTS:

Diagnostic accuracy of K-ras mutation analysis and of combined diagnostic strategy by using EUS-FNA and K-ras mutation analysis in the diagnosis of PADC.

RESULTS:

The pooled sensitivity of EUS-FNA for the differential diagnosis of PADC was 80.6%, and the specificity was 97%. Estimated sensitivity and specificity were 76.8% and 93.3% for K-ras gene analysis, respectively, and 88.7% and 92% for combined EUS-FNA plus K-ras mutation analysis. Overall, K-ras mutation testing applied to cases that were inconclusive by EUS-FNA reduced the false-negative rate by 55.6%, with a false-positive rate of 10.7%. Not repeating EUS-FNA in cases in which mutation testing of the K-ras gene is inconclusive would reduce the repeat-biopsy rate from 12.5% to 6.8%.

LIMITATIONS:

Small number of studies and between-study heterogeneity.

CONCLUSION:

K-ras mutation analysis can be useful in the diagnostic work-up of pancreatic masses, in particular when tissue obtained by EUS-FNA is insufficient, and the diagnosis inconclusive.

KEYWORDS:

PADC; QUADAS; Quality Assessment of Diagnostic Accuracy Studies; pancreatic adenocarcinoma

PMID:
23660563
DOI:
10.1016/j.gie.2013.04.162
[Indexed for MEDLINE]

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