Reviewing the Utility of EUS FNA to Advance Precision Medicine in Pancreatic Cancer

Abstract

Advanced pancreatic cancer (PC) is an aggressive malignancy with few effective therapeutic options. While the evolution of precision medicine in recent decades has changed the treatment landscape in many cancers, at present no targeted therapies are used in the routine management of PC. Only a minority of patients with PC present with surgically resectable disease, and in the remainder obtaining high quality biopsy material for both diagnosis and molecular testing can prove challenging. Endoscopic ultrasound-guided fine needle aspiration (EUS FNA) is a widely used diagnostic procedure in PC, and allows tumour sampling in patients with both early and late stage disease. This review will provide an update on the role of EUS FNA as a diagnostic tool, as well as a source of genetic material which can be used both for molecular analysis and for the creation of valuable preclinical disease models. We will also consider relevant clinical applications of EUS FNA in the management of PC, and the path towards bringing precision medicine closer to the clinic in this challenging disease.

Needle Biopsy Adequacy in the Era of Precision Medicine and Value-Based Health Care

“…[201][202][203] However, EUS needle biopsy has advantages over open biopsy to sample chemotherapy-naïve tumors and to provide material for genomic analysis, for example KRAS mutations 204 and immunophenotype analysis. 205 Against the significant hazards of open biopsy, inadequacy rates of EUS needle biopsy can be tolerated. Endoscopic ultrasound-guided needle biopsy is also extremely useful for accessing and selecting metastatic tumor present in the peritoneum.…”

Endoscopic ultrasound-guided fine needle aspiration for pancreatic cancer

“…Subsequently, in the era of precision medicine, its application has shifted from diagnosis to molecular profiling for potential targets for personalized anticancer therapy. Even though we still have many issues that limit the clinical application of precision medicine to PC, EUS -FNA may play an important role in precision medicine for PC in the future 32) .…”

Usefulness of rapid on-site evaluation specimens from endoscopic ultrasound-guided fine-needle aspiration for cancer gene panel testing: A retrospective study

“…In recent years, the development of precision medicine has changed the treatment of many cancers, such as breast cancer, melanoma, colorectal cancer, and lung cancer [6]. Although KRAS, TP53, CDKN2A, and SMAD4 mutations are representative gene mutations of PC [7] [8], in many cases, 12 core signaling pathways have been shown to be potential therapeutic targets for precision medicine [9].…”