内镜超声细针穿刺物K—ras基因突变检测对胰腺癌的诊断价值  

The diagnostic value of the K-ras mutation detection of endoscopic ultrasound-guided fine needle aspiration specimen for pancreatic carcinoma

作　　者：王晓光 杨晓丹 费鸣剑 亓立峰[2] 钟征翔 

机构地区：[1]嘉兴医学院附属第二医院肝胆外科,浙江嘉兴314000 [2]同济大学医学院生物医学工程和纳米科学研究院

出　　处：《中华胰腺病杂志》2017年第5期307-310,共4页Chinese Journal of Pancreatology

基　　金：浙江省科技厅公益技术研究社会发展项目（2014C33139）

摘　　要：目的探讨内镜超声引导下细针穿刺（EUS－FNA）标本K－ras基因突变检测对胰腺癌的诊断价值。方法收集2013年1月至2015年12月嘉兴医学院附属第二医院收治的78例胰腺癌患者和40例胰腺良性疾病患者。所有患者均经EUS－FNA取得病灶的细胞或组织条块。抽提标本DNA，应用特异性纳米捕获探针体系检测K－ras基因12、13位点密码子突变，并行液基细胞学检查。比较两种检测方法的敏感性及特异性。结果78例胰腺癌患者EUS－FNA穿刺物的K－ras基因突变率为92.3%（72/78），显著高于胰腺良性疾病患者的20.4%（10/49），差异有统计学意义（χ2＝68.002，P＝0.000）。EUS－FNA穿刺物液基细胞学检查诊断胰腺癌的敏感性为75.6%，特异性为87.8%，约登指数为0.634，阳性预测值为6.196，阴性预测值为0.227；K－ras基因突变诊断胰腺癌的敏感性为92.3%，特异性为79.6%，约登指数为0.719，阳性预测值为4.524，阴性预测值为0.096。K－ras基因突变对胰腺癌诊断的敏感性显著高于细胞学检查，差异有统计学意义（χ2＝8.47，P＝0.004）。K－ras基因突变联合细胞学检查的诊断敏感性提高到94.9%，特异性提高到95.9%，其中特异性显著高于单纯K－ras基因突变检测，差异有统计学意义（χ2＝6.13，P＝0.013）。结论采用纳米捕获探针检测EUS－FNA穿刺物K－ras基因突变可提高对胰腺癌诊断的敏感性，联合细胞学检查能进一步提高诊断的敏感性及特异性，对于胰腺癌的诊断价值更高。ObjectiveTo explore the diagnostic value of k ras mutation detection of specimen obtained by endoscopic ultrasound-guided fine needle aspiration（EUS-FNA）for pancreatic cancer.MethodsSeventy-eight patients with pancreatic carcinoma and 49 patients with pancreatic benign diseases were collected from January 2013 to December 2015.All the patients underwent EUS-FNA and cell or tissue samples were collected. DNA was extracted from the samples, and the codon 12 and 13 mutation of K-ras gene was detected by specific nano capture probe. Liquid cytology was also conducted. The sensitivity and specificity of the two methods were compared.ResultsThe K-ras mutation rate was 92.3%（72/78） in 78 patients with pancreatic carcinoma, which was obviously higher than the mutation rate of 20.4%（10/49） in 49 patients with pancreatic benign tumors, and the difference was statistically significant （χ2=68.002, P=0.000）. The sensitivity of the cytology examination of EUS-FNA specimens in the diagnosis of pancreatic carcinoma was 75.6%, the specificity was 87.8%, Youden index was 0.634, the positive and negative predictive value was 6.196 and 0.227. The detection of K-ras mutations had a sensitivity of 92.3% and a specificity of 79.6% in the diagnosis of pancreatic carcinoma, the Youden index was 0.719, the positive and negative predictive value was 4.524 and 0.096. K-ras mutation detection had a higher sensitivity compared with cytology, and the difference was statistically significant （χ2=8.47, P=0.004）. The sensitivity was 94.9% and specificity of 95.9% using the combination of K-ras mutations and cytology for diagnosing pancreatic cancer, and the specificity was obviously increased compared with only k ras mutation detection and the difference was statistically significant （χ2=6.13, P=0.013）.ConclusionsK-ras mutation detection of EUS-FNA specimen using nano capture probe system can significantly improve the sensitivity of diagnosing pancreatic cancer, and the sensitivity and specificity could be further impro

关 键 词：胰腺肿瘤 腔内超声检查 突变 磁性纳米粒子 

分 类 号：R735.9[医药卫生—肿瘤]