Evaluation of Local Recurrence of Pancreatic Cancer by KRAS Mutation Analysis Using Washes from Endoscopic Ultrasound-Gu
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ORIGINAL ARTICLE
Evaluation of Local Recurrence of Pancreatic Cancer by KRAS Mutation Analysis Using Washes from Endoscopic Ultrasound‑Guided Fine‑Needle Aspiration Kazuyuki Matsumoto1 · Hironari Kato1 · Kazuhiro Nouso1 · Soichiro Ako1 · Hideaki Kinugasa1 · Shigeru Horiguchi1 · Yosuke Saragai1 · Saimon Takada1 · Shuntaro Yabe1 · Shinichiro Muro1 · Daisuke Uchida1 · Takeshi Tomoda1 · Hiroyuki Okada1 Received: 24 February 2019 / Accepted: 10 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background and Aims The sensitivity of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for diagnosing the recurrence of pancreatic cancer is usually low because of difficulties in obtaining adequate samples for pathological examinations. We evaluated the efficacy of highly sensitive KRAS mutation analysis using EUS-FNA washes to detect cancer recurrence. Methods Nineteen consecutive patients with suspected pancreatic cancer recurrence after surgical resection were enrolled. All underwent EUS-FNA, and samples were obtained for pathological examination. After the first session, the inside of the FNA needle was washed with saline for DNA extraction. KRAS mutations were examined using digital droplet PCR (dPCR). Results The median needle puncture number used to obtain adequate pathological samples was two (range 1–6). In ten patients pathologically diagnosed with malignant pancreatic cancer, nine patients tested positive for a KRAS mutation. All patients who were not diagnosed with a malignant pancreatic cancer tested negative for a KRAS mutation. About half of surgically resected primary cancers (9/19) showed double KRAS mutations (G12V and G12D); however, all but one wash sample showed a single KRAS mutation, G12D. After including one patient who showed a malignant recurrence during follow-up, the sensitivities of a pathological diagnosis and KRAS analysis to detect recurrence were 90.9% and 81.8%, respectively. Conclusions KRAS mutation analysis of needle wash samples using dPCR is a new methodology for the diagnosis of the local recurrence of pancreatic cancer. The diagnostic ability of dPCR with a one-time needle wash sample was comparable to a pathological diagnosis with multiple samplings. Keywords EUS-FNA · Pancreatic cancer · Local recurrence · KRAS mutation · Digital PCR * Kazuhiro Nouso [email protected]
Shuntaro Yabe [email protected]
Kazuyuki Matsumoto [email protected]
Shinichiro Muro [email protected]
Hironari Kato katou‑[email protected]‑u.ac.jp
Daisuke Uchida [email protected]
Soichiro Ako [email protected]
Takeshi Tomoda [email protected]
Hideaki Kinugasa [email protected]
Hiroyuki Okada [email protected]‑u.ac.jp
Shigeru Horiguchi [email protected]
1
Yosuke Saragai [email protected]
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, 2‑5‑1 Shikata‑cho, Okayama 700‑8558, Japan
Saimon Takada riberu4@g
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