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Testing cyst fluid for a panel of gene mutations alongside the clinical picture classified 130 removed pancreatic cysts almost perfectly and would have avoided nine in ten of the operations that turned out to be unnecessary.
Multicentre retrospective study of 130 patients with resected pancreatic cystic neoplasms (12 serous cystadenomas, 10 solid pseudopapillary neoplasms, 12 mucinous cystic neoplasms, 96 IPMNs). Cyst fluid was analysed for mutations in BRAF, CDKN2A, CTNNB1, GNAS, KRAS, NRAS, PIK3CA, RNF43, SMAD4, TP53 and VHL, loss of heterozygosity at CDKN2A, RNF43, SMAD4, TP53 and VHL, and aneuploidy. Molecular markers with clinical features classified cyst type with 90 to 100% sensitivity and 92 to 98% specificity; the marker panel correctly identified 67 of the 74 patients who did not need surgery, a potential 91% reduction in unnecessary operations.
The evidence that molecular cyst-fluid testing can spare operations, now part of specialist practice although not a universal standard.
Shares Biopsy, Luis A. Diaz Jr., GNAS, Bert Vogelstein.
Shares Gastroenterology, GNAS, Bert Vogelstein, CDKN2A.
Shares Gastroenterology, GNAS, SMAD4, Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors.
Shares GNAS, RNF43, SMAD4, Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors.
Shares RNF43, CTNNB1, Bert Vogelstein, Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors.
Shares Biopsy, Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors, Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center, Pancreatic ductal adenocarcinoma.
Shares Bert Vogelstein, SMAD4, CDKN2A, Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center.