Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS FNA) of Cystic Pancreatic Lesions: What Is the Value of Molecular and Chemical Analysis of Cyst Fluid in Diagnostic and Nondiagnostic Samples?
Wenping Li, Susie Nguyen, Nadim Haddad, Therese Cermak, Mary Sidawy. MedStar Georgetown University Hospital, Washington, DC
Background: Cystic lesions of the pancreas are often complex and heterogeneous with low diagnostic yield by EUS FNA. We evaluated whether molecular analysis for loss of heterozygosity (LOH) and KRAS point mutations, as well as chemical analysis for CEA, assisted in classifying these lesions.
Design: We identified 65 cystic pancreatic lesions collected by EUS FNA since 2010 that had cyst fluid sent for molecular testing and chemical analysis. The cytologic, histologic, molecular and chemical results were reviewed.
Results: Of 65 cases, EUS FNA results were nondiagnostic in 74% (48) compared with our overall nondiagnostic rate for pancreatic EUS FNA of 26%. The 48 nondiagnostic samples had material sent for molecular analysis. KRAS mutations were detected in 15 (31%) and 7 had surgical follow-up with results summarized in Table 1.
|Surgical follow-up||KRAS||LOH||CEA (ng/ml)*|
|FNA Diagnosis||Surgical follow-up||KRAS||LOH||CEA (ng/ml)*|
|Mucinous cystic lesion||IPMN, LG||Y||N||L|
|Mucinous cystic lesion||IPMN, inv CA||-||-||H|