K-ras mutation detected by peptide nucleic acid-clamping polymerase chain reaction, Ki-67, S100P, and SMAD4 expression can improve the diagnostic accuracy of inconclusive pancreatic EUS-FNB specimens

Bo-Hyung Kim ¹, Minji Kwon ², Donghwan Lee ³

⁰Department of Clinical Pharmacology and Therapeutics, Kyung Hee University Hospital, Seoul, South Korea; East-West Medical Research Institute, Kyung Hee University, Seoul, South Korea.

Pancreatology : Official Journal of the International Association of Pancreatology (iap) ... [et Al.] +

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May 1, 2024

View abstract on PubMed

Summary

Detecting K-ras mutations using peptide nucleic acid-clamping polymerase chain reaction offers a reliable method for diagnosing pancreatic lesions. Combining K-ras mutation with markers like Ki-67, S100P, and SMAD4 improves accuracy in difficult cases.

Area Of Science

Gastroenterology and Hepatology
Oncology
Molecular Diagnostics

Background

Accurate diagnosis of pancreatic solid lesions is crucial for effective treatment.
Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is a primary diagnostic tool.
Histological evaluation can be challenging in inconclusive cases.

Purpose Of The Study

To evaluate the diagnostic utility of an immunohistochemical panel and K-ras mutation analysis.
To assess the markers' effectiveness in diagnosing pancreatic solid lesions from EUS-FNB specimens.
To confirm marker usefulness in histologically inconclusive cases.

Main Methods

Immunohistochemistry and K-ras mutation analysis (peptide nucleic acid-clamping PCR) on 96 EUS-FNB specimens.
Evaluation of individual and combined marker diagnostic efficacy.
Assessment of diagnostic performance in 27 histologically inconclusive cases.

Main Results

K-ras mutation demonstrated the highest accuracy and consistency.
Combinations of markers (e.g., >3) achieved high diagnostic accuracy (up to 94.6%).
A classification tree using K-ras, Ki-67, S100P, and SMAD4 showed high performance in inconclusive cases.

Conclusions

K-ras mutation detection is a stable and accurate method for differentiating pancreatic ductal adenocarcinoma.
A classification tree incorporating K-ras, Ki-67, S100P, and SMAD4 enhances diagnostic accuracy for challenging cases.

Keywords:

Immunohistochemistry K-ras PNA-Clamping Pancreatic carcinoma Sono-guided biopsy