Does EUSFNA molecular analysis carry additional value when compared to cytology in the diagnosis of pancreatic cystic neoplasm? A systematic review

Abstract

k-ras mutational analysis used as an individual screening test has a poor diagnostic accuracy, as does cytology when used alone. The benefit comes with utilization in a combined fashion. More studies are needed to evaluate the correct sequence and utility of these tests for cyst differentiation.

Cytologic categorization of pancreatic neoplastic mucinous cysts with an assessment of the risk of malignancy: A retrospective study based on the Papanicolaou Society of Cytopathology guidelines

“…11,12 In terms of molecular analyses for predicting malignancy in a mucinous cyst, there are currently insufficient data to warrant their usage in routine practice. 25,30,31 The cytologic recognition of high-grade atypia or worse in our study resulted in an overall sensitivity of 48.3% and an accuracy of 84.3% for detecting malignancy in pancreatic mucinous cysts. In comparison, at the threshold of a positive cytology diagnosis, the sensitivity and accuracy for detecting malignancy were 10.3% and 75.6%, respectively.…”

Diagnosis of pancreatic lesions collected by endoscopic ultrasound-guided fine-needle aspiration using next-generation sequencing

“…Among them, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become an important method of diagnosing pancreatic tumors due to its high safety, cost-effectiveness and accuracy (3,4). EUS-FNA demonstrates high sensitivity for histological diagnosis (75–94%) and a specificity approaching 100% in the majority of studies (5,6). However, false-negative, atypical and suspicious cytopathological diagnoses remain relatively frequent (5,7,8).…”

Endoscopic diagnosis of cystic lesions of the pancreas

“…Combination of KRAS mutation analysis and CEA concentration measurements improved the diagnostic sensitivity of the latter alone from 67% to 84% for mucinous cysts . A recent systematic review of 12 articles showed that the combination of cytology and KRAS analysis was useful diagnostically (sensitivity, 71%; specificity, 88%), although KRAS mutational analysis alone had a poor diagnostic ability (sensitivity, 39%; specificity, 95%) . Singhi et al .…”

“…35 A recent systematic review of 12 articles showed that the combination of cytology and KRAS analysis was useful diagnostically (sensitivity, 71%; specificity, 88%), although KRAS mutational analysis alone had a poor diagnostic ability (sensitivity, 39%; specificity, 95%). 36 Singhi et al 37 evaluated 626 pancreatic cyst fluids obtained by EUS-FNA using next-generation sequencing and showed that the combination of KRAS/GNAS mutations and TP53/ PIK3CA/PTEN alternation analyses had a sensitivity of 89% and a specificity of 100% for diagnosing advanced neoplasia.…”