A comparative analysis of K-ras mutation and carcinoembryonic antigen in pancreatic cyst fluid |
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| Authors: | Renata Talar-Wojnarowska Marek Pazurek Lukasz Durko Malgorzata Degowska Grazyna Rydzewska Jacek Smigielski Adam Janiak Marek Olakowski Pawel Lampe Piotr Grzelak Ludomir Stefanczyk Beata Smolarz Ewa Malecka-Panas |
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| Affiliation: | 1. Department of Digestive Tract Diseases, Medical University of Lodz, Kopcinskiego 22, 90-153 Lodz, Poland;2. Department of Gastroenterology, Central Clinical Hospital of Ministry of Interior and Administration, Warsaw, Poland;3. Department of Thoracic Surgery, General and Oncological Surgery, Medical University of Lodz, Poland;4. Department of Gastroenterological, Oncological and General Surgery, Medical University of Lodz, Poland;5. Department of Surgery of Digestive Tract Diseases, Silesian Medical University, Katowice, Poland;6. Department of Radiology, Medical University of Lodz, Poland;7. Laboratory of Molecular Genetics, Institute of Polish Mother''s Memorial Hospital, Lodz, Poland;1. Wellcome-DBT India Alliance Laboratory, Asian Healthcare Foundation, Department of Medical Gastroenterology, Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad 500082, India;2. Department of Medical Gastroenterology, Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad 500082, India;1. Department of Gastroenterology and Hepatology of Medical University of Gdańsk, Gdańsk, Poland;2. Department of Radiology of Medical University of Gdańsk, Poland;3. Department of General, Endocrine and Transplant Surgery of Medical University of Gdańsk, Poland;1. Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri, USA;2. Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA;3. Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA;4. Division of Gastroenterology, Feinberg School of Medicine Northwestern University, Chicago, Illinois, USA;5. Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA;6. Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Denver, Colorado, USA;1. Department of Laboratory Medicine and Pathobiology, University of Toronto, University Health Network, Toronto, ON, Canada;2. Department of Pathology, Lakeridge Hospital, University of Toronto, Oshawa, ON, Canada;3. Department of Pathology, University of Massachusetts Medical School, Worcester, Massachusetts;1. Department of Gasroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan;2. Department of Endoscopy, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan;3. Department of Gastrointestinal Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan;4. Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan;5. Department of Medical Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi 110070, India;1. Imperial College London, South Kensington Campus, Exhibition Road, London, United Kingdom;2. St Mary''s Hospital, London, United Kingdom;3. Chelsea & Westminster Hospital, London, United Kingdom;4. West Middlesex University Hospital, Imperial College, London, United Kingdom |
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| Abstract: | Background/aimsAnalysis of cystic fluid may be useful in distinguishing between benign and malignant cysts which has significant impact on their management. The aim of our study was to assess the diagnostic utility of carcinoembryonic antigen (CEA) and K-ras gene mutation in pancreatic cysts fluid.MethodsThe study included 56 patients with pancreatic cystic fluid collected for analysis. The cysts were classified as benign (simple cysts, pseudocysts, serous cystadenoma) - 39 patients or premalignant/malignant (mucinous cystadenoma, IPMN, cystadenocarcinoma) - 17 patients. The patients history, CEA fluid concentrations and presence of K-ras mutation were analyzed.ResultsCEA were higher in patients with malignant cysts (mean levels 238 ± 12.5 ng/ml; range 32.8–4985 ng/ml) compared to benign lesions (mean levels 34.5 ± 3.7 ng/ml; range 3.9–693 ng/ml; p < 0.001). K-ras mutation correctly classified 11 of 17 patients with premalignant/malignant lesions. It was also detected in 1 patient with final diagnosis of benign cyst (the sensitivity 64.7% and the specificity 97.4%; p < 0.01). If CEA and molecular analysis were combined in that cysts with either CEA level>45 ng/ml or presence of K-ras mutation, than 16 of 17 premalignant/malignant cysts were correctly identified (94.1%).ConclusionMolecular analysis of pancreatic cyst fluid adds diagnostic value to the preoperative diagnosis and should be considered when cyst cytologic examination is negative for malignancy. |
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