Performance characteristics of molecular (DNA) analysis for the diagnosis of mucinous pancreatic cysts

Mohammad Al-Haddad, John DeWitt, Stuart Sherman, C. Schmidt, Julia K. Leblanc, Lee McHenry, Gregory Coté, Abdul Hamid El Chafic, Leticia Luz, Jennifer Schaffter Stuart, Cynthia S. Johnson, Christen Klochan, Thomas Imperiale

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Abstract

Background Diagnosis of mucinous pancreatic cysts (MPCs) is challenging due to the poor sensitivity of cytology provided by EUS-guided-FNA (EUS-FNA). Objective To quantify the test characteristics of molecular (DNA) analysis in suspected low-risk MPCs. Design A prospective cohort study performed in between 2008 and 2011. Setting Academic referral center. Patients Consecutive patients who underwent EUS-FNA of suspected MPCs. Intervention EUS-FNA and molecular (DNA) analysis of cyst fluid. Main Outcome Measurements The sensitivity and specificity of molecular analysis in the diagnosis of MPCs using the criterion standard of surgical pathology in resected cysts. Results Patients with suspected MPCs underwent EUS-FNA and cyst fluid DNA analysis. Surgical resection was performed in 48 patients (17%), confirming a mucinous pathology in 38 (79%). In this group, molecular analysis had a sensitivity of 50% and a specificity of 80% in identifying MPCs (accuracy of 56.3%). The combination of molecular analysis with cyst fluid carcinoembryonic antigen (CEA) and cytology resulted in higher MPC diagnostic performance than either one of its individual components, with a sensitivity, specificity, and accuracy of 73.7%, 70%, and 72.9%, respectively. There was no significant difference in accuracy between molecular analysis and CEA/cytology in this group. Limitations Single-center experience. Conclusion Molecular analysis aids in the diagnosis of MPCs when cytology is nondiagnostic or cyst fluid is insufficient for CEA or its level is indeterminate. Our results do not support the routine use of molecular analysis, which should be used selectively after review of imaging findings and cyst fluid studies. Further studies are needed to assess DNA's performance in malignant cysts.

Original languageEnglish
Pages (from-to)79-87
Number of pages9
JournalGastrointestinal Endoscopy
Volume79
Issue number1
DOIs
StatePublished - Jan 2014

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Pancreatic Cyst
Cyst Fluid
Endoscopic Ultrasound-Guided Fine Needle Aspiration
DNA
Cell Biology
Carcinoembryonic Antigen
Cysts
Sensitivity and Specificity
Surgical Pathology
Cohort Studies
Referral and Consultation
Prospective Studies
Pathology

Keywords

  • carcinoembryonic antigen
  • carcinoembryonic antigen/cytology diagnosis
  • CCD
  • CEA
  • EUS-FNA
  • EUS-guided FNA
  • HGD
  • high-grade dysplasia
  • intraductal papillary mucinous neoplasm
  • IPMN
  • LGD
  • LOH
  • loss of heterozygosity
  • low-grade dysplasia
  • MCN
  • MPC
  • mucinous cystic neoplasm
  • mucinous pancreatic cyst

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Performance characteristics of molecular (DNA) analysis for the diagnosis of mucinous pancreatic cysts. / Al-Haddad, Mohammad; DeWitt, John; Sherman, Stuart; Schmidt, C.; Leblanc, Julia K.; McHenry, Lee; Coté, Gregory; El Chafic, Abdul Hamid; Luz, Leticia; Stuart, Jennifer Schaffter; Johnson, Cynthia S.; Klochan, Christen; Imperiale, Thomas.

In: Gastrointestinal Endoscopy, Vol. 79, No. 1, 01.2014, p. 79-87.

Research output: Contribution to journalArticle

Al-Haddad, Mohammad ; DeWitt, John ; Sherman, Stuart ; Schmidt, C. ; Leblanc, Julia K. ; McHenry, Lee ; Coté, Gregory ; El Chafic, Abdul Hamid ; Luz, Leticia ; Stuart, Jennifer Schaffter ; Johnson, Cynthia S. ; Klochan, Christen ; Imperiale, Thomas. / Performance characteristics of molecular (DNA) analysis for the diagnosis of mucinous pancreatic cysts. In: Gastrointestinal Endoscopy. 2014 ; Vol. 79, No. 1. pp. 79-87.
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abstract = "Background Diagnosis of mucinous pancreatic cysts (MPCs) is challenging due to the poor sensitivity of cytology provided by EUS-guided-FNA (EUS-FNA). Objective To quantify the test characteristics of molecular (DNA) analysis in suspected low-risk MPCs. Design A prospective cohort study performed in between 2008 and 2011. Setting Academic referral center. Patients Consecutive patients who underwent EUS-FNA of suspected MPCs. Intervention EUS-FNA and molecular (DNA) analysis of cyst fluid. Main Outcome Measurements The sensitivity and specificity of molecular analysis in the diagnosis of MPCs using the criterion standard of surgical pathology in resected cysts. Results Patients with suspected MPCs underwent EUS-FNA and cyst fluid DNA analysis. Surgical resection was performed in 48 patients (17{\%}), confirming a mucinous pathology in 38 (79{\%}). In this group, molecular analysis had a sensitivity of 50{\%} and a specificity of 80{\%} in identifying MPCs (accuracy of 56.3{\%}). The combination of molecular analysis with cyst fluid carcinoembryonic antigen (CEA) and cytology resulted in higher MPC diagnostic performance than either one of its individual components, with a sensitivity, specificity, and accuracy of 73.7{\%}, 70{\%}, and 72.9{\%}, respectively. There was no significant difference in accuracy between molecular analysis and CEA/cytology in this group. Limitations Single-center experience. Conclusion Molecular analysis aids in the diagnosis of MPCs when cytology is nondiagnostic or cyst fluid is insufficient for CEA or its level is indeterminate. Our results do not support the routine use of molecular analysis, which should be used selectively after review of imaging findings and cyst fluid studies. Further studies are needed to assess DNA's performance in malignant cysts.",
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N2 - Background Diagnosis of mucinous pancreatic cysts (MPCs) is challenging due to the poor sensitivity of cytology provided by EUS-guided-FNA (EUS-FNA). Objective To quantify the test characteristics of molecular (DNA) analysis in suspected low-risk MPCs. Design A prospective cohort study performed in between 2008 and 2011. Setting Academic referral center. Patients Consecutive patients who underwent EUS-FNA of suspected MPCs. Intervention EUS-FNA and molecular (DNA) analysis of cyst fluid. Main Outcome Measurements The sensitivity and specificity of molecular analysis in the diagnosis of MPCs using the criterion standard of surgical pathology in resected cysts. Results Patients with suspected MPCs underwent EUS-FNA and cyst fluid DNA analysis. Surgical resection was performed in 48 patients (17%), confirming a mucinous pathology in 38 (79%). In this group, molecular analysis had a sensitivity of 50% and a specificity of 80% in identifying MPCs (accuracy of 56.3%). The combination of molecular analysis with cyst fluid carcinoembryonic antigen (CEA) and cytology resulted in higher MPC diagnostic performance than either one of its individual components, with a sensitivity, specificity, and accuracy of 73.7%, 70%, and 72.9%, respectively. There was no significant difference in accuracy between molecular analysis and CEA/cytology in this group. Limitations Single-center experience. Conclusion Molecular analysis aids in the diagnosis of MPCs when cytology is nondiagnostic or cyst fluid is insufficient for CEA or its level is indeterminate. Our results do not support the routine use of molecular analysis, which should be used selectively after review of imaging findings and cyst fluid studies. Further studies are needed to assess DNA's performance in malignant cysts.

AB - Background Diagnosis of mucinous pancreatic cysts (MPCs) is challenging due to the poor sensitivity of cytology provided by EUS-guided-FNA (EUS-FNA). Objective To quantify the test characteristics of molecular (DNA) analysis in suspected low-risk MPCs. Design A prospective cohort study performed in between 2008 and 2011. Setting Academic referral center. Patients Consecutive patients who underwent EUS-FNA of suspected MPCs. Intervention EUS-FNA and molecular (DNA) analysis of cyst fluid. Main Outcome Measurements The sensitivity and specificity of molecular analysis in the diagnosis of MPCs using the criterion standard of surgical pathology in resected cysts. Results Patients with suspected MPCs underwent EUS-FNA and cyst fluid DNA analysis. Surgical resection was performed in 48 patients (17%), confirming a mucinous pathology in 38 (79%). In this group, molecular analysis had a sensitivity of 50% and a specificity of 80% in identifying MPCs (accuracy of 56.3%). The combination of molecular analysis with cyst fluid carcinoembryonic antigen (CEA) and cytology resulted in higher MPC diagnostic performance than either one of its individual components, with a sensitivity, specificity, and accuracy of 73.7%, 70%, and 72.9%, respectively. There was no significant difference in accuracy between molecular analysis and CEA/cytology in this group. Limitations Single-center experience. Conclusion Molecular analysis aids in the diagnosis of MPCs when cytology is nondiagnostic or cyst fluid is insufficient for CEA or its level is indeterminate. Our results do not support the routine use of molecular analysis, which should be used selectively after review of imaging findings and cyst fluid studies. Further studies are needed to assess DNA's performance in malignant cysts.

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KW - LGD

KW - LOH

KW - loss of heterozygosity

KW - low-grade dysplasia

KW - MCN

KW - MPC

KW - mucinous cystic neoplasm

KW - mucinous pancreatic cyst

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