KRAS Mutations in Duodenal Lavage Fluid after Secretin Stimulation for Detection of Pancreatic Cancer.

IF 7.5 1区医学 Q1 SURGERY

Annals of surgery Pub Date : 2025-02-04 DOI:10.1097/SLA.0000000000006645

Shinichi Yachida, Shigetaka Yoshinaga, Satoshi Shiba, Makiko Urabe, Hidenori Tanaka, Yohei Takeda, Akinori Shimizu, Yuri Sakamoto, Susumu Hijioka, Shin Haba, Reiko Ashida, Yoshinori Kushiyama, Kento Asano, Makiko Kobayashi, Yoshiyuki Murawaki, Kouji Onishi, Taro Yamashita, Hirokazu Kimura, Yasushi Totoki, Hideki Kamada, Hajime Isomoto, Satoshi Hattori, Chigusa Morizane, Kazuyoshi Ohkawa, Masayuki Kitano, Kazuo Hara, Kenji Ikezawa, Keiji Hanada, Kazuya Matsumoto

{"title":"KRAS Mutations in Duodenal Lavage Fluid after Secretin Stimulation for Detection of Pancreatic Cancer.","authors":"Shinichi Yachida, Shigetaka Yoshinaga, Satoshi Shiba, Makiko Urabe, Hidenori Tanaka, Yohei Takeda, Akinori Shimizu, Yuri Sakamoto, Susumu Hijioka, Shin Haba, Reiko Ashida, Yoshinori Kushiyama, Kento Asano, Makiko Kobayashi, Yoshiyuki Murawaki, Kouji Onishi, Taro Yamashita, Hirokazu Kimura, Yasushi Totoki, Hideki Kamada, Hajime Isomoto, Satoshi Hattori, Chigusa Morizane, Kazuyoshi Ohkawa, Masayuki Kitano, Kazuo Hara, Kenji Ikezawa, Keiji Hanada, Kazuya Matsumoto","doi":"10.1097/SLA.0000000000006645","DOIUrl":null,"url":null,"abstract":"Objective: Although pancreatic ductal adenocarcinoma (PDAC) is still a devastating disease, the survival rate for surgically removed PDACs has significantly improved in recent years. Early detection is essential in managing PDAC.Summary background data: The presence of KRAS mutations in PDAC leads to the initial genetic abnormality and offers a significant timeframe for identifying resectable PDACs. A minimally invasive and highly specific PDAC screening test is necessary to prevent the need for invasive follow-up tests.Methods: Between July 2021 and March 2023, 169 cases were enrolled in 7 institutions. By administering secretin before esophagogastroduodenoscopy (EGD), the excretion of pancreatic juice into the papillary fluid can be stimulated, creating a resource for testing. Washing fluid was collected using a specialized catheter from control individuals (n=75) and patients with resectable PDAC (n=89) at the initial diagnosis. A highly sensitive technique was employed to study KRAS gene mutations.Results: This study obtained an AUC of 0.934 [95%CI: 0.904, 0.964] when using KRAS mutations in duodenal lavage fluid to differentiate between patients with resectable PDAC and healthy controls. The estimated sensitivities were calculated with specificity set at 100%, resulting in a sensitivity of 83.1% [95%CI: 71.7%, 91.2%]. The McNemer test showed a significantly higher sensitivity for KRAS mutations than serum CEA and CA19-9 (P<0.0001).Conclusions: We created a method to identify resectable PDACs by analyzing KRAS mutation levels in duodenal fluid collected during EGD with secretin stimulation of pancreatic juice secretion.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5000,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/SLA.0000000000006645","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Objective: Although pancreatic ductal adenocarcinoma (PDAC) is still a devastating disease, the survival rate for surgically removed PDACs has significantly improved in recent years. Early detection is essential in managing PDAC.

Summary background data: The presence of KRAS mutations in PDAC leads to the initial genetic abnormality and offers a significant timeframe for identifying resectable PDACs. A minimally invasive and highly specific PDAC screening test is necessary to prevent the need for invasive follow-up tests.

Methods: Between July 2021 and March 2023, 169 cases were enrolled in 7 institutions. By administering secretin before esophagogastroduodenoscopy (EGD), the excretion of pancreatic juice into the papillary fluid can be stimulated, creating a resource for testing. Washing fluid was collected using a specialized catheter from control individuals (n=75) and patients with resectable PDAC (n=89) at the initial diagnosis. A highly sensitive technique was employed to study KRAS gene mutations.

Results: This study obtained an AUC of 0.934 [95%CI: 0.904, 0.964] when using KRAS mutations in duodenal lavage fluid to differentiate between patients with resectable PDAC and healthy controls. The estimated sensitivities were calculated with specificity set at 100%, resulting in a sensitivity of 83.1% [95%CI: 71.7%, 91.2%]. The McNemer test showed a significantly higher sensitivity for KRAS mutations than serum CEA and CA19-9 (P<0.0001).

Conclusions: We created a method to identify resectable PDACs by analyzing KRAS mutation levels in duodenal fluid collected during EGD with secretin stimulation of pancreatic juice secretion.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Annals of surgery 医学-外科

CiteScore

14.40

自引率

4.40%

发文量

687

审稿时长

4 months

期刊介绍： The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.