Echoendoscopic ultrasound pancreatic adenocarcinoma diagnosis and theranostic approach: should KRAS mutation research be recommended in everyday practice?

• Published in: Therapeutic advances in gastroenterology Vol. 17; p. 17562848231224943
• Main Authors: Béchade, Dominique, Palmieri, Lola-Jade, Bonhomme, Benjamin, Pernot, Simon, Léna, Jeanne, Fonck, Marianne, Pesqué, Sophie, Boillet, Gautier, Italiano, Antoine, Roseau, Gilles
• Format: Journal Article
• Language: English
• Published: England 2024
• Subjects: EUS-FNB; KRAS mutation; pancreatic cancer treatment; Idylla® test; pancreatic cancer diagnosis; next-generation sequencing; theranostic impact; pancreatic ductal adenocarcinoma
• ISSN: 1756-283X; 1756-2848; 1756-2848
• DOI: 10.1177/17562848231224943

The impact of mutation testing on pancreatic ductal adenocarcinoma (PDAC) samples by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for reducing the need to repeat EUS-FNA has been demonstrated. Such testing however is not part of standard practice for endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB). We aim to analyse the proportion of non-contributive samples by EUS-FNB and to evaluate the impact of mutation testing on the diagnosis, theranostics and survival. In this retrospective study, the impact on diagnosis and survival of testing for contributive and non-contributive samples by EUS-FNB was analysed. The EUS-FNB samples, combined with testing using the Idylla technique on liquid-based cytology from patients with PDAC between February 2019 and May 2023, were retrospectively reviewed. The cytology results were classified according to the guidelines of the World Health Organization System for Reporting Pancreaticobiliary Cytopathology (WHOSRPC). A total of 85 EUS-FNB specimens were reviewed. In all, 25 EUS-FNB samples did not lead to a formal diagnosis of PDAC according to the WHOSRPC (30.2%). Out of these 25, 11 (44%) could have been considered positive for a PDAC diagnosis thanks to the mutation test without carrying out further diagnosis procedures. The sensitivity of mutation testing using the Idylla technique was 98.6%. According to the available data, survival rates were not statistically different depending on the type of mutation. mutation testing on liquid-based cytology using the Idylla or equivalent technique, combined with the PDAC EUS-FNB sample, should become a standard for diagnosis to avoid delaying treatment by doing another biopsy. Furthermore, knowledge of the status from treatment initiation could be used to isolate mutations requiring targeted treatments or inclusion in clinical research trials, especially for wild-type PDAC.