Clinical usefulness of K-ras gene mutation detection and cytology in pancreatic juice in the diagnosis and screening of pancreatic cancer

Background The significance of K-ras codon 12 mutation in pancreatic juice is still unclear. Although considerable controversy surrounds this question , the diagnostic utility of K-ras in patients with clinical suspicion of pa ncreatic cancer (PC) and in PC-risk patients remains unknown. Objective To study prospectively the utility of the K-ras gene mutation and cytology in the diagnosis and screening of PC, and to assess its contribut ion to clinical decision making. Methods Pancreatic juice samples obtained from 90 patients were evaluated p rospectively. Group I (n = 40) comprised patients with clinical suspicion o f PC; group II (n = 50) comprised 49 patients with chronic pancreatitis and one patient proceeding from a PC family screening. The K-ras mutation was detected by means of artificial restriction fragment length polymorphisms ( RFLP) in DNA after polymerase chain reaction (PCR) amplification. Results In group I, of those patients with a definitive diagnosis of PC, ma lignant cells were found in 27% and K-ras mutation in 44%. In five cases, m olecular analysis contributed to diagnosis (4/11 with negative cytology and 1/2 with insufficient cytological material). K-ras mutation revealed an ea rly tumour in one patient, and was the only sample available for diagnosis in another. In group II, the K-ras gene mutation was detected in 8/49 patie nts (16%) with chronic pancreatitis, one of whom developed PC (2%). Conclusions K-ras mutation analysis of pancreatic juice may complement cyto logical evaluation in the diagnosis of PC, in spite of its limited contribu tion to clinical decision making. The presence of K-ras mutation in chronic pancreatitis classifies a subgroup of PC-risk patients who should be evalu ated carefully by long-term follow-up. Eur J Gastroenterol Hepatol 13:1153- 1159 (C) 2001 Lippincott Williams & Wilkins.