摘要目的 检测内镜超声引导下细针穿刺穿刺物中K-ras基因的突变,探讨其对胰腺癌早期诊断的价值.方法 收集27例胰腺癌、9例其他恶性肿瘤及14例良性胰腺占位患者的细针穿刺物,应用肽核酸(PNA)钳制PCR法检测K-ras突变.结果 胰腺癌患者K-ras突变阳性率为88.9%,其他恶性肿瘤为44.4%,良性胰腺占位为35.7%,胰腺癌与其他两种病变差异显著(P=0.013,P=0.001).胰腺癌与其他恶性肿瘤比较,K-ras基因突变的敏感性、特异性、阳性预测率、阴性预测率、准确率分别为88.9%、55.6%、85.7%、62.5%、80.6%,差异显著(P=0.013);与良性胰腺占位病变比较,分别为88.9%、64.3%、82.8%、75.0%、80.5%,差异亦显著(P=0.001).联合穿刺物细胞学检查和K-ras基因突变检测,胰腺癌的阳性率高达96.3%.结论 胰腺组织穿刺物的K-ras基因突变检测可提高胰腺癌诊断的阳性率.

abstractsObjective To investigate the diagnostic value of the K-ras mutations in FNA samples for early detection of pancreatic cancer. Methods FNA samples of 27 patients with pancreatic cancers, 9 patients with other malignant tumors and 14 patients with non malignant pancreatic mass (NMPM) were collected. DNA was extracted, and K-ras gene was amplified through PNA-mediated PGR clamping, the products were sequenced to determine the mutation type. Results The positive rate of K-ras mutations in pancreatic cancers,other malignant tumors and NMPM were 88.9%, 44.4%, 35.7%. There was significant difference in K-ras gene mutations in FNA samples between pancreatic cancer and other malignant tumors ( P = 0. 013 ) and NMPM ( P = 0. 001 ). The sensitivity, specificity, positive predictive value, negative predictive value,accuracy of K-ras mutations in FNA samples of pancreatic cancers were 88.9%, 55.6%, 85.7%, 62.5%,80.6% when compared with other malignant tumors, and the difference between the two groups was significant (P =0. 013) ;Those were 88.9%, 64.3%, 82.8%, 75.0%, 80. 5% when compared with NMPM, and the difference between the two groups was significant ( P = 0. 001 ). When cytology of FNA samples and K-ras mutations was combined, the positive rate of pancreatic cancer was up to 96.3%. Conclusions The detection of K-ras mutations in EUS-FNA samples helped improve the positive diagnostic rate of pancreatic cancer.