TY - JOUR
T1 - The role of K-ras gene mutation analysis in EUS-guided FNA cytology specimens for the differential diagnosis of pancreatic solid masses
T2 - A meta-analysis of prospective studies
AU - Fuccio, Lorenzo
AU - Hassan, Cesare
AU - Laterza, Liboria
AU - Correale, Loredana
AU - Pagano, Nico
AU - Bocus, Paolo
AU - Fabbri, Carlo
AU - Maimone, Antonella
AU - Cennamo, Vincenzo
AU - Repici, Alessandro
AU - Costamagna, Guido
AU - Bazzoli, Franco
AU - Larghi, Alberto
PY - 2013/10
Y1 - 2013/10
N2 - 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.
AB - 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.
KW - PADC
KW - pancreatic adenocarcinoma
KW - QUADAS
KW - Quality Assessment of Diagnostic Accuracy Studies
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U2 - 10.1016/j.gie.2013.04.162
DO - 10.1016/j.gie.2013.04.162
M3 - Article
C2 - 23660563
AN - SCOPUS:84884415511
VL - 78
SP - 596
EP - 608
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
SN - 0016-5107
IS - 4
ER -