■通过内窥镜超声引导的细针抽吸术(EUS-FNA)对胰腺导管腺癌(PDAC)样本进行KRAS突变检测以减少重复EUS-FNA的需要。然而,这种测试不是内窥镜超声引导的细针活检(EUS-FNB)的标准实践的一部分。
■我们旨在分析EUS-FNB的非贡献样本比例,并评估KRAS突变检测对诊断的影响,治疗和生存。
■在这项回顾性研究中,分析了EUS-FNB对有贡献和无贡献样本的KRAS检测对诊断和生存率的影响.
■EUS-FNB样本,在2019年2月至2023年5月期间,我们对PDAC患者进行了采用Idylla®技术的液基细胞学检查,并结合KRAS检测.根据世界卫生组织胰胆管细胞病理学报告系统(WHOSRPC)的指南对细胞学结果进行分类。
■共审查了85个EUS-FNB标本。总之,根据WHOSRPC(30.2%),25个EUS-FNB样品未导致PDAC的正式诊断。在这25个中,有11个(44%)由于KRAS突变测试而被认为是PDAC诊断阳性,而无需执行进一步的诊断程序。使用Idylla技术进行KRAS突变测试的灵敏度为98.6%。根据现有数据,根据突变类型的不同,生存率无统计学差异.
■使用Idylla或等效技术在液基细胞学上进行KRAS突变测试,结合PDACEUS-FNB样本,应成为诊断标准,以避免因再次活检而延迟治疗。此外,从治疗开始到KRAS状态的知识可用于分离需要靶向治疗或纳入临床研究试验的突变,特别是野生型KRASPDAC。
在胰腺腺癌的超声超声活检中寻找KRAS突变的诊断和治疗兴趣由于这些肿瘤具有特定微环境的性质,胰腺腺癌的超声诊断有时仍然困难。30多年来,几位作者强调了在超声超声内镜采集的样本中搜索KRAS突变以提高诊断性能的重要性.然而,这项研究并不常见。我们的回顾性研究使回顾85例胰腺腺癌患者的档案成为可能,这些患者进行了超声内镜超声活检,并搜索了KRAS突变(第二代细针活检)。由于在没有重复新样本的情况下搜索了KRAS突变,因此可以认为有44%的PDAC诊断为阳性。此外,从诊断中了解KRAS突变类型将有可能分离出证明可能的靶向治疗的突变.
UNASSIGNED: The impact of KRAS mutation testing on pancreatic ductal adenocarcinoma (PDAC) samples by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for reducing the need to repeat EUS-FNA has been demonstrated. Such testing however is not part of standard practice for endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB).
UNASSIGNED: We aim to analyse the proportion of non-contributive samples by EUS-FNB and to evaluate the impact of KRAS mutation testing on the diagnosis, theranostics and survival.
UNASSIGNED: In this retrospective study, the impact on diagnosis and survival of KRAS testing for contributive and non-contributive samples by EUS-FNB was analysed.
UNASSIGNED: The EUS-FNB samples, combined with KRAS testing using the Idylla® technique on liquid-based cytology from patients with PDAC between February 2019 and May 2023, were retrospectively reviewed. The cytology results were classified according to the guidelines of the World Health Organization System for Reporting Pancreaticobiliary Cytopathology (WHOSRPC).
UNASSIGNED: A total of 85 EUS-FNB specimens were reviewed. In all, 25 EUS-FNB samples did not lead to a formal diagnosis of PDAC according to the WHOSRPC (30.2%). Out of these 25, 11 (44%) could have been considered positive for a PDAC diagnosis thanks to the KRAS mutation test without carrying out further diagnosis procedures. The sensitivity of KRAS mutation testing using the Idylla technique was 98.6%. According to the available data, survival rates were not statistically different depending on the type of mutation.
UNASSIGNED: KRAS mutation testing on liquid-based cytology using the Idylla or equivalent technique, combined with the PDAC EUS-FNB sample, should become a standard for diagnosis to avoid delaying treatment by doing another biopsy. Furthermore, knowledge of the KRAS status from treatment initiation could be used to isolate mutations requiring targeted treatments or inclusion in clinical research trials, especially for wild-type KRAS PDAC.
Diagnostic and theranostic interest of searching for a KRAS mutation in echoendoscopic ultrasound biopsies of pancreatic adenocarcinomas The echoendoscopic ultrasound diagnostic of pancreatic adenocarcinomas sometimes remains difficult due to the nature of these tumors with a particular microenvironment. For more than 30 years, several authors have underlined the importance of searching for a KRAS mutation on samples taken by echoendoscopic ultrasound to improve diagnostic performance. However, this research is not common practice. Our retrospective study made it possible to review the files of 85 patients with pancreatic adenocarcinoma in whom an echoendoscopic ultrasound biopsy was performed with a search for the KRAS mutation (with second-generation fine needle biopsy). Forty-four percent could have been considered positive for the diagnosis of PDAC thanks to the search for the KRAS mutation without repeating new samples. Furthermore, knowledge of the KRAS mutation type from diagnosis would make it possible to isolate mutations justifying possible targeted treatments.