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Background  Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) technology is widely used for the diagnosis of pancreatic masses. However, in some cases, inadequate tissue volume or difficulty of morphological diagnosis are constraining factors for adequate cytopathological evaluation.  K-ras  mutation is the most frequently acquired genetic abnormality, occurring in approximately 90% of all patients with pancreatic ductal adenocarcinoma (PDAC). In the present study, the clinical utility of residual liquid-based cytology (LBC) specimens obtained using EUS-FNA for  K-ras  mutation analysis was evaluated.    Methods  In this study, 81 patients with pancreatic lesions were examined. The cell block (CB) specimens separated from EUS-FNA samples were morphologically evaluated by hematoxylin–eosin (HE) staining. Final diagnoses were confirmed by CB specimens, surgical resection specimens, diagnostic imaging, and clinical follow-up. Genomic DNA of residual LBC specimens stored at 4°C for several months were extracted and assessed for  K-ras  mutations using a fluorescence resonance energy transfer-based preferential homoduplex formation assay.    Results   K-ras  mutation analysis using residual LBC samples was successful in all cases. The sensitivity, specificity, and accuracy of CB examination alone were 77.4%, 100%, and 81.3%, respectively, and those of the combination of CB examination and  K-ras  mutation analysis were 90.3%, 92.3%, and 90.7%, respectively. Furthermore,  K-ras  mutations were detected in 8 (57.1%) of 14 PDAC samples for which the CB results were inconclusive.    Conclusion  These findings suggest that  K-ras  mutation analysis using residual LBC specimens improves the diagnostic accuracy of EUS-FNA.

plos one

K-ras mutation analysis of residual liquid-based cytology specimens from endoscopic ultrasound-guided fine needle aspiration improves cell block diagnosis of pancreatic ductal adenocarcinoma