The role of K-ras gene mutation analysis in EUS-guided FNA cytology specimens for the differential diagnosis of pancreatic solid masses: A meta-analysis of prospective studies

Lorenzo Fuccio, Cesare Hassan, Liboria Laterza, Loredana Correale, Nico Pagano, Paolo Bocus, Carlo Fabbri, Antonella Maimone, Vincenzo Cennamo, Alessandro Repici, Guido Costamagna, Franco Bazzoli, Alberto Larghi

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)596-608
Number of pages13
JournalGastrointestinal Endoscopy
Volume78
Issue number4
DOIs
Publication statusPublished - Oct 2013

Keywords

  • PADC
  • pancreatic adenocarcinoma
  • QUADAS
  • Quality Assessment of Diagnostic Accuracy Studies

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

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    Fuccio, L., Hassan, C., Laterza, L., Correale, L., Pagano, N., Bocus, P., Fabbri, C., Maimone, A., Cennamo, V., Repici, A., Costamagna, G., Bazzoli, F., & Larghi, A. (2013). The role of K-ras gene mutation analysis in EUS-guided FNA cytology specimens for the differential diagnosis of pancreatic solid masses: A meta-analysis of prospective studies. Gastrointestinal Endoscopy, 78(4), 596-608. https://doi.org/10.1016/j.gie.2013.04.162