Preoperative next-generation sequencing of pancreatic cyst fluid is highly accurate in cyst classification and detection of advanced neoplasia

Aatur D. Singhi, Kevin McGrath, Randall E. Brand, Asif Khalid, Herbert J. Zeh, Jennifer S. Chennat, Kenneth E. Fasanella, Georgios I. Papachristou, Adam Slivka, David L. Bartlett, Anil K. Dasyam, Melissa Hogg, Kenneth K. Lee, James Wallis Marsh, Sara E. Monaco, N. Paul Ohori, James F. Pingpank, Allan Tsung, Amer H. Zureikat, Abigail I. WaldMarina N. Nikiforova

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Objective: DNA-based testing of pancreatic cyst fluid (PCF) is a useful adjunct to the evaluation of pancreatic cysts (PCs). Mutations in KRAS/GNAS are highly specific for intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs), while TP53/PIK3CA/PTEN alterations are associated with advanced neoplasia. A prospective study was performed to evaluate preoperative PCF DNA testing. Design: Over 43-months, 626 PCF specimens from 595 patients were obtained by endoscopic ultrasound (EUS)-fine needle aspiration and assessed by targeted next-generation sequencing (NGS). Molecular results were correlated with EUS findings, ancillary studies and follow-up. A separate cohort of 159 PCF specimens was also evaluated for KRAS/GNAS mutations by Sanger sequencing. Results: KRAS/GNAS mutations were identified in 308 (49%) PCs, while alterations in TP53/PIK3CA/PTEN were present in 35 (6%) cases. Based on 102 (17%) patients with surgical follow-up, KRAS/GNAS mutations were detected in 56 (100%) IPMNs and 3 (30%) MCNs, and associated with 89% sensitivity and 100% specificity for a mucinous PC. In comparison, KRAS/GNAS mutations by Sanger sequencing had a 65% sensitivity and 100% specificity. By NGS, the combination of KRAS/GNAS mutations and alterations in TP53/PIK3CA/PTEN had an 89% sensitivity and 100% specificity for advanced neoplasia. Ductal dilatation, a mural nodule and malignant cytopathology had lower sensitivities (42%, 32% and 32%, respectively) and specificities (74%, 94% and 98%, respectively). Conclusions: In contrast to Sanger sequencing, preoperative NGS of PCF for KRAS/GNAS mutations is highly sensitive for IPMNs and specific for mucinous PCs. In addition, the combination of TP53/PIK3CA/PTEN alterations is a useful preoperative marker for advanced neoplasia.

Original languageEnglish (US)
JournalGut
DOIs
StateAccepted/In press - Sep 28 2017
Externally publishedYes

Fingerprint

Pancreatic Cyst
Cyst Fluid
Cysts
Mutation
Neoplasms
Sensitivity and Specificity
DNA
Fine Needle Biopsy
Dilatation
Prospective Studies

Keywords

  • pancreatic cancer
  • pancreatic epidemiology
  • pancreatic pathology
  • pancreato-biliary disorders

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Preoperative next-generation sequencing of pancreatic cyst fluid is highly accurate in cyst classification and detection of advanced neoplasia. / Singhi, Aatur D.; McGrath, Kevin; Brand, Randall E.; Khalid, Asif; Zeh, Herbert J.; Chennat, Jennifer S.; Fasanella, Kenneth E.; Papachristou, Georgios I.; Slivka, Adam; Bartlett, David L.; Dasyam, Anil K.; Hogg, Melissa; Lee, Kenneth K.; Marsh, James Wallis; Monaco, Sara E.; Ohori, N. Paul; Pingpank, James F.; Tsung, Allan; Zureikat, Amer H.; Wald, Abigail I.; Nikiforova, Marina N.

In: Gut, 28.09.2017.

Research output: Contribution to journalArticle

Singhi, AD, McGrath, K, Brand, RE, Khalid, A, Zeh, HJ, Chennat, JS, Fasanella, KE, Papachristou, GI, Slivka, A, Bartlett, DL, Dasyam, AK, Hogg, M, Lee, KK, Marsh, JW, Monaco, SE, Ohori, NP, Pingpank, JF, Tsung, A, Zureikat, AH, Wald, AI & Nikiforova, MN 2017, 'Preoperative next-generation sequencing of pancreatic cyst fluid is highly accurate in cyst classification and detection of advanced neoplasia', Gut. https://doi.org/10.1136/gutjnl-2016-313586
Singhi, Aatur D. ; McGrath, Kevin ; Brand, Randall E. ; Khalid, Asif ; Zeh, Herbert J. ; Chennat, Jennifer S. ; Fasanella, Kenneth E. ; Papachristou, Georgios I. ; Slivka, Adam ; Bartlett, David L. ; Dasyam, Anil K. ; Hogg, Melissa ; Lee, Kenneth K. ; Marsh, James Wallis ; Monaco, Sara E. ; Ohori, N. Paul ; Pingpank, James F. ; Tsung, Allan ; Zureikat, Amer H. ; Wald, Abigail I. ; Nikiforova, Marina N. / Preoperative next-generation sequencing of pancreatic cyst fluid is highly accurate in cyst classification and detection of advanced neoplasia. In: Gut. 2017.
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title = "Preoperative next-generation sequencing of pancreatic cyst fluid is highly accurate in cyst classification and detection of advanced neoplasia",
abstract = "Objective: DNA-based testing of pancreatic cyst fluid (PCF) is a useful adjunct to the evaluation of pancreatic cysts (PCs). Mutations in KRAS/GNAS are highly specific for intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs), while TP53/PIK3CA/PTEN alterations are associated with advanced neoplasia. A prospective study was performed to evaluate preoperative PCF DNA testing. Design: Over 43-months, 626 PCF specimens from 595 patients were obtained by endoscopic ultrasound (EUS)-fine needle aspiration and assessed by targeted next-generation sequencing (NGS). Molecular results were correlated with EUS findings, ancillary studies and follow-up. A separate cohort of 159 PCF specimens was also evaluated for KRAS/GNAS mutations by Sanger sequencing. Results: KRAS/GNAS mutations were identified in 308 (49{\%}) PCs, while alterations in TP53/PIK3CA/PTEN were present in 35 (6{\%}) cases. Based on 102 (17{\%}) patients with surgical follow-up, KRAS/GNAS mutations were detected in 56 (100{\%}) IPMNs and 3 (30{\%}) MCNs, and associated with 89{\%} sensitivity and 100{\%} specificity for a mucinous PC. In comparison, KRAS/GNAS mutations by Sanger sequencing had a 65{\%} sensitivity and 100{\%} specificity. By NGS, the combination of KRAS/GNAS mutations and alterations in TP53/PIK3CA/PTEN had an 89{\%} sensitivity and 100{\%} specificity for advanced neoplasia. Ductal dilatation, a mural nodule and malignant cytopathology had lower sensitivities (42{\%}, 32{\%} and 32{\%}, respectively) and specificities (74{\%}, 94{\%} and 98{\%}, respectively). Conclusions: In contrast to Sanger sequencing, preoperative NGS of PCF for KRAS/GNAS mutations is highly sensitive for IPMNs and specific for mucinous PCs. In addition, the combination of TP53/PIK3CA/PTEN alterations is a useful preoperative marker for advanced neoplasia.",
keywords = "pancreatic cancer, pancreatic epidemiology, pancreatic pathology, pancreato-biliary disorders",
author = "Singhi, {Aatur D.} and Kevin McGrath and Brand, {Randall E.} and Asif Khalid and Zeh, {Herbert J.} and Chennat, {Jennifer S.} and Fasanella, {Kenneth E.} and Papachristou, {Georgios I.} and Adam Slivka and Bartlett, {David L.} and Dasyam, {Anil K.} and Melissa Hogg and Lee, {Kenneth K.} and Marsh, {James Wallis} and Monaco, {Sara E.} and Ohori, {N. Paul} and Pingpank, {James F.} and Allan Tsung and Zureikat, {Amer H.} and Wald, {Abigail I.} and Nikiforova, {Marina N.}",
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TY - JOUR

T1 - Preoperative next-generation sequencing of pancreatic cyst fluid is highly accurate in cyst classification and detection of advanced neoplasia

AU - Singhi, Aatur D.

AU - McGrath, Kevin

AU - Brand, Randall E.

AU - Khalid, Asif

AU - Zeh, Herbert J.

AU - Chennat, Jennifer S.

AU - Fasanella, Kenneth E.

AU - Papachristou, Georgios I.

AU - Slivka, Adam

AU - Bartlett, David L.

AU - Dasyam, Anil K.

AU - Hogg, Melissa

AU - Lee, Kenneth K.

AU - Marsh, James Wallis

AU - Monaco, Sara E.

AU - Ohori, N. Paul

AU - Pingpank, James F.

AU - Tsung, Allan

AU - Zureikat, Amer H.

AU - Wald, Abigail I.

AU - Nikiforova, Marina N.

PY - 2017/9/28

Y1 - 2017/9/28

N2 - Objective: DNA-based testing of pancreatic cyst fluid (PCF) is a useful adjunct to the evaluation of pancreatic cysts (PCs). Mutations in KRAS/GNAS are highly specific for intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs), while TP53/PIK3CA/PTEN alterations are associated with advanced neoplasia. A prospective study was performed to evaluate preoperative PCF DNA testing. Design: Over 43-months, 626 PCF specimens from 595 patients were obtained by endoscopic ultrasound (EUS)-fine needle aspiration and assessed by targeted next-generation sequencing (NGS). Molecular results were correlated with EUS findings, ancillary studies and follow-up. A separate cohort of 159 PCF specimens was also evaluated for KRAS/GNAS mutations by Sanger sequencing. Results: KRAS/GNAS mutations were identified in 308 (49%) PCs, while alterations in TP53/PIK3CA/PTEN were present in 35 (6%) cases. Based on 102 (17%) patients with surgical follow-up, KRAS/GNAS mutations were detected in 56 (100%) IPMNs and 3 (30%) MCNs, and associated with 89% sensitivity and 100% specificity for a mucinous PC. In comparison, KRAS/GNAS mutations by Sanger sequencing had a 65% sensitivity and 100% specificity. By NGS, the combination of KRAS/GNAS mutations and alterations in TP53/PIK3CA/PTEN had an 89% sensitivity and 100% specificity for advanced neoplasia. Ductal dilatation, a mural nodule and malignant cytopathology had lower sensitivities (42%, 32% and 32%, respectively) and specificities (74%, 94% and 98%, respectively). Conclusions: In contrast to Sanger sequencing, preoperative NGS of PCF for KRAS/GNAS mutations is highly sensitive for IPMNs and specific for mucinous PCs. In addition, the combination of TP53/PIK3CA/PTEN alterations is a useful preoperative marker for advanced neoplasia.

AB - Objective: DNA-based testing of pancreatic cyst fluid (PCF) is a useful adjunct to the evaluation of pancreatic cysts (PCs). Mutations in KRAS/GNAS are highly specific for intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs), while TP53/PIK3CA/PTEN alterations are associated with advanced neoplasia. A prospective study was performed to evaluate preoperative PCF DNA testing. Design: Over 43-months, 626 PCF specimens from 595 patients were obtained by endoscopic ultrasound (EUS)-fine needle aspiration and assessed by targeted next-generation sequencing (NGS). Molecular results were correlated with EUS findings, ancillary studies and follow-up. A separate cohort of 159 PCF specimens was also evaluated for KRAS/GNAS mutations by Sanger sequencing. Results: KRAS/GNAS mutations were identified in 308 (49%) PCs, while alterations in TP53/PIK3CA/PTEN were present in 35 (6%) cases. Based on 102 (17%) patients with surgical follow-up, KRAS/GNAS mutations were detected in 56 (100%) IPMNs and 3 (30%) MCNs, and associated with 89% sensitivity and 100% specificity for a mucinous PC. In comparison, KRAS/GNAS mutations by Sanger sequencing had a 65% sensitivity and 100% specificity. By NGS, the combination of KRAS/GNAS mutations and alterations in TP53/PIK3CA/PTEN had an 89% sensitivity and 100% specificity for advanced neoplasia. Ductal dilatation, a mural nodule and malignant cytopathology had lower sensitivities (42%, 32% and 32%, respectively) and specificities (74%, 94% and 98%, respectively). Conclusions: In contrast to Sanger sequencing, preoperative NGS of PCF for KRAS/GNAS mutations is highly sensitive for IPMNs and specific for mucinous PCs. In addition, the combination of TP53/PIK3CA/PTEN alterations is a useful preoperative marker for advanced neoplasia.

KW - pancreatic cancer

KW - pancreatic epidemiology

KW - pancreatic pathology

KW - pancreato-biliary disorders

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