Clinical Research Papers:

Additional K-ras mutation analysis and Plectin-1 staining improve the diagnostic accuracy of pancreatic solid mass in EUS-guided fine needle aspiration

Joo Kyung Park _, Woo Hyun Paik, Byeong Jun Song, Ji Kon Ryu, Min A. Kim, Jin Myung Park, Sang Hyub Lee and Yong-Tae Kim

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Oncotarget. 2017; 8:64440-64448. https://doi.org/10.18632/oncotarget.16135

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Joo Kyung Park1,*, Woo Hyun Paik2,4,*, Byeong Jun Song3,*, Ji Kon Ryu4, Min A. Kim5, Jin Myung Park4, Sang Hyub Lee4 and Yong-Tae Kim4

1 Department of Medicine, Division of Gastroenterology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

2 Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea

3 Department of Internal Medicine, Myongji Hospital, Goyang, Korea

4 Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

5 Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

* These authors have contributed equally to this work as first authors

Correspondence to:

Ji Kon Ryu, email:

Keywords: pancreatic ductal adenocarcinoma; endoscopic ultrasound; K-ras; Plectin-1

Received: January 02, 2017 Accepted: March 04, 2017 Published: March 11, 2017


Background: One of the major genetic alterations in pancreatic ductal adenocarcinoma (PDAC) is the point mutation of K-ras gene. Plectin-1 was also recently identified as PDAC specific biomarker. The aim of this study was to investigate the improvement of diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) by using additional K-ras mutation analysis and Plectin-1 staining in patients with pancreatic mass.

Methods: A total of 85 study patients with pancreatic mass underwent EUS-FNA and the final diagnoses were as follows; PDACs: 70 patients, pancreas neuroendocrine tumor: 4, metastasis to pancreas: 5, autoimmune pancreatitis: 3, chronic pancreatitis: 1, tuberculous lymphadenitis: 1, pseudocyst: 1.

Results: Sensitivity, specificity and accuracy of pathologic diagnosis in EUS-FNA specimen were 81%, 80% and 79% accordingly. When we combine K-ras gene mutation analysis with histological assessment, we could get the following results for sensitivity, specificity and accuracy; cytology and K-ras mutation analysis: 93%, 87%, and 92%, cytology, K-ras mutation analysis, and Plectin-1 staining: 96%, 93%, and 95%.

Conclusions: Triple combinations of the techniques; cytology, K-ras gene mutation analysis, Plectin-1 staining could increase accuracy in diagnosis of PDACs. Further investigation of using minimal specimens from EUS-FNA may give us insight to understand the biological behavior of PDAC.

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