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World J Gastroenterol. Aug 21, 2014; 20(31): 10758-10768
Published online Aug 21, 2014. doi: 10.3748/wjg.v20.i31.10758
Role of endoscopic ultrasound in the molecular diagnosis of pancreatic cancer
Barbara Bournet, Marion Gayral, Jérôme Torrisani, Janick Selves, Pierre Cordelier, Louis Buscail
Barbara Bournet, Louis Buscail, Department of Gastroenterology, CHU Toulouse Rangueil, University of Toulouse, 31059 Toulouse, France
Barbara Bournet, Marion Gayral, Jérôme Torrisani, Janick Selves, Pierre Cordelier, Louis Buscail, INSERM UMR 1037, CHU Toulouse Rangueil, University of Toulouse, 31059 Toulouse, France
Janick Selves, Department of Pathology, CHU Toulouse Purpan, University of Toulouse, 31059 Toulouse, France
Author contributions: Bournet B, Selves J, Cordelier P and Buscail L collected and analysed the data, designed and wrote the manuscript; Gayral M and Torrisani J wrote and revised the manuscript.
Correspondence to: Louis Buscail, MD, PhD, Department of Gastroenterology, CHU Toulouse Rangueil, University of Toulouse, 1 avenue Jean Poulhès, TSA 50032, 31059 Toulouse, France. buscail.l@chu-toulouse.fr
Telephone: +33-5-61323055 Fax: +33-5-61322229
Received: October 28, 2013
Revised: January 12, 2014
Accepted: April 15, 2014
Published online: August 21, 2014
Abstract

Pancreatic ductal adenocarcinoma remains one of the most deadly types of tumor. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a safe, cost-effective, and accurate technique for evaluating and staging pancreatic tumors. However, EUS-FNA may be inconclusive or doubtful in up to 20% of cases. This review underlines the clinical interest of the molecular analysis of samples obtained by EUS-FNA in assessing diagnosis or prognosis of pancreatic cancer, especially in locally advanced tumors. On EUS-FNA materials DNA, mRNA and miRNA can be extracted, amplified, quantified and subjected to methylation assay. Kras mutation assay, improves diagnosis of pancreatic cancer. When facing to clinical and radiological presentations of pseudo-tumorous chronic pancreatitis, wild-type Kras is evocative of benignity. Conversely, in front of a pancreatic mass suspected of malignancy, a mutated Kras is highly evocative of pancreatic adenocarcinoma. This strategy can reduce false-negative diagnoses, avoids the delay of making decisions and reduces loss of surgical resectability. Similar approaches are conducted using analysis of miRNA expression as well as Mucin or markers of invasion (S100P, S100A6, PLAT or PLAU). Beyond the diagnosis approach, the prediction of response to treatment can be also investigated form biomarkers expression within EUS-FNA materials.

Keywords: Pancreatic ductal adenocarcinoma, Endoscopic ultrasound-guided fine-needle aspiration, Solid pancreatic mass, KRAS-mutation assay, qPCR analysis, Micro-RNA, Chronic pancreatitis

Core tip: This review depicts the widespread potential for the molecular analysis of samples obtained by ultrasound-guided fine needle aspiration in assessing diagnosis or prognosis of pancreatic adenocarcinoma, as well as translational studies on new markers and epigenetic alterations. Among these markers, Kras oncogene assay appears now the most robust for improvement of positive and differential diagnosis of pancreatic cancer. Clinical implication of miRNA, Mucins and markers of invasion is still debated. Future molecular developments may open windows towards personalized treatments after molecular characterization of a single patient.