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Mansour Y, Boubaddi M, Odion T, Marty M, Belleannée G, Berger A, Subtil C, Laurent C, Dabernat S, Amintas S. Droplet digital polymerase chain reaction detection of KRAS mutations in pancreatic FNA samples: Technical and practical aspects for routine clinical implementation. Cancer Cytopathol 2024. [PMID: 38308613 DOI: 10.1002/cncy.22795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND Pancreatic adenocarcinoma (PDAC) is associated with a 5-year survival rate of less than 6%, and current treatments have limited efficacy. The diagnosis of PDAC is mainly based on a cytologic analysis of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) samples. However, the collected specimens may prove noncontributory in a significant number of cases, delaying patient management and treatment. The combination of EUS-FNA sample examination and KRAS mutation detection can improve the sensitivity for diagnosis. In this context, the material used for molecular analysis may condition performance. METHODS The authors prospectively compared the performance of cytologic analysis combined with a KRAS droplet digital polymerase chain reaction (ddPCR) assay for PDAC diagnosis using either conventional formalin-fixed, paraffin-embedded cytologic samples or needle-rinsing fluids. RESULTS Molecular testing of formalin-fixed, paraffin-embedded cytologic samples was easier to set up, but the authors observed that the treatment of preanalytic samples, in particular the fixation process, drastically reduced ddPCR sensitivity, increasing the risk of false-negative results. Conversely, the analysis of dedicated, fresh needle-rinsing fluid samples appeared to be ideal for ddPCR analysis; it had greater sensitivity and was easily to implement in clinical use. In particular, fluid collection by the endoscopist, transportation to the laboratory, and subsequent freezing did not affect DNA quantity or quality. Moreover, the addition of KRAS mutation detection to cytologic examination improved diagnosis performance, regardless of the source of the sample. CONCLUSIONS Considering all of these aspects, the authors propose the use of an integrated flowchart for the KRAS molecular testing of EUS-FNA samples in clinical routine.
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Affiliation(s)
- Yara Mansour
- Pathology Department, Bordeaux University Hospital Center (CHU Bordeaux), Bordeaux, France
| | - Mehdi Boubaddi
- Digestive Surgery Department, CHU Bordeaux, Pessac, France
- Bordeaux Institute of Oncology, UMR Unit 1312, INSERM, University of Bordeaux, Bordeaux, France
| | - Typhaine Odion
- Pathology Department, Bordeaux University Hospital Center (CHU Bordeaux), Bordeaux, France
| | - Marion Marty
- Pathology Department, Bordeaux University Hospital Center (CHU Bordeaux), Bordeaux, France
| | - Geneviève Belleannée
- Pathology Department, Bordeaux University Hospital Center (CHU Bordeaux), Bordeaux, France
| | - Arthur Berger
- Gastroenterology and Hepatology Department, CHU Bordeaux, Pessac, France
| | - Clément Subtil
- Gastroenterology and Hepatology Department, CHU Bordeaux, Pessac, France
| | - Christophe Laurent
- Digestive Surgery Department, CHU Bordeaux, Pessac, France
- Bordeaux Institute of Oncology, UMR Unit 1312, INSERM, University of Bordeaux, Bordeaux, France
| | - Sandrine Dabernat
- Bordeaux Institute of Oncology, UMR Unit 1312, INSERM, University of Bordeaux, Bordeaux, France
- Biochemistry Laboratory, CHU Bordeaux, Pessac, France
| | - Samuel Amintas
- Bordeaux Institute of Oncology, UMR Unit 1312, INSERM, University of Bordeaux, Bordeaux, France
- Tumor Biology and Tumor Bank Laboratory, CHU Bordeaux, Pessac, France
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