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A morphological and immunohistochemical study of the endoscopic ultrasound-fine-needle biopsy samples from solid
Alexandru Constantinescu1, Cristina Mădălina Ilie-Stan, Vasile Şandru
1Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, Romania; bogdan.ungureanu@umfcv.ro.
Insights
Endoscopic ultrasound-fine-needle biopsy (EUS-FNB) provides sufficient tissue for diagnosing pancreatic tumors and aids in immunohistochemistry (IHC) analysis. CK7 positivity is linked to increased survival in pancreatic cancer patients.
Area of Science:
- Gastroenterology
- Oncology
- Pathology
Background:
- Pancreatic solid tumors pose diagnostic challenges.
- Accurate histopathological (HP) and immunohistochemistry (IHC) assessments are crucial for treatment planning.
Purpose of the Study:
- To present single-center experience with endoscopic ultrasound-fine-needle biopsy (EUS-FNB) for pancreatic solid tumors.
- To evaluate the utility of EUS-FNB for obtaining tissue for IHC assays.
Main Methods:
- Prospective study of 57 patients with pancreatic solid tumors from January 2018 to February 2020.
- EUS-FNB performed, with tissue analyzed for HP diagnosis and IHC if needed.
- Immunohistochemical markers included CK7, CK20, CDX2, mismatch repair proteins, chromogranin A, and synaptophysin.
Main Results:
- EUS-FNB provided adequate tissue for HP and IHC analysis.
- Univariate analysis revealed stage, tumor location, surgical management, and CK7 positivity as significant factors influencing survival.
- Advanced stage (regional/metastatic) and tumor location in the tail decreased survival.
- CK7 positivity significantly increased survival in pancreatic cancer patients.
Conclusions:
- EUS-FNB is a valuable tool for pancreatic tumor diagnosis, yielding sufficient tissue for HP and IHC.
- A panel of immunomarkers, including CK7, can aid in diagnosis and potentially guide new therapies for pancreatic cancer.
Objective:
The purpose of this study was to present the experience of a single center on endoscopic ultrasound-fine-needle biopsy (EUS-FNB) of pancreatic solid tumors amenable to immunohistochemistry (IHC) assay.
Patients, Materials And Methods:
Inclusion criterion for this prospective study was identifying patients with pancreatic solid tumors, by means of imaging methods, from January 2018 to February 2020, within the Department of Gastroenterology, Emergency Clinical Hospital, Bucharest, Romania. All patients underwent EUS-FNB and the harvested tissue was sent to the Department of Pathology for histopathological (HP) diagnosis and IHC assessment if tumoral origin remained undetermined.
Results:
A total of 57 patients were ultimately selected to take part in our study. We performed immunohistochemical analysis based on the morphological diagnosis of the pancreatic tumors and assessed cytokeratin (CK)7, CK20, caudal type homeobox 2 (CDX2), MutL homolog 1 (MLH1), MutS homolog (MSH)2, MSH6, postmeiotic segregation 2 (PMS2) for all histopathologically uncertain pancreatic ductal adenocarcinoma (PDAC) and chromogranin A, synaptophysin, pan-CK AE1∕AE3 for pancreatic neuroendocrine tumors (pNETs). Cox hazard regression was performed to identify the factors influencing the survival rate. In univariate analysis, patient survival time was significantly associated with stage, location, surgical management and CK7 positivity. Our data show a statistically significant predictive relationship between stage (regional or metastatic) and hazard for survival (p=0.015). Tumoral location in the tail (p=0.015) and radicality surgery (p=0.015) significantly decrease the survival of pancreatic cancer (PAC) patients. The presence of CK7 (p=0.015) significantly increases the survival of pancreas cancer patients.
Conclusions:
EUS-FNB has opened up a new path for pancreatic tumor diagnosis providing enough tissue for HP examination and IHC. A panel of several immunomarkers might aid in providing new therapies for PAC patients.
