Description of technique for EUS-guided tissue acquisition in pancreatic cancer for comprehensive molecular profiling: Results of a randomized trial

Aims As theoretically actionable genomic lesions are found in 50% of pancreatic cancers which can impact clinical management in up to 30% of patients, there is increased focus on molecular profiling. Although EUS-FNB is an established method for pathological diagnosis in pancreatic cancers, technique for comprehensive molecular profiling (CMP) has not been described.

Methods Patients with pancreatic adenocarcinoma on ROSE at EUS were randomized to 2 or 3 dedicated FNB passes for CMP. Tissue was procured using 22G Franseen needle adopting fanning technique and stylet-retraction maneuver. Genomic DNA and total RNA were extracted from cell blocks. Next-generation sequencing was performed for analyzing 69 gene DNA mutations and 53 RNA somatic oncogenic gene fusions. Main outcome measure was specimens in which adequate DNA and RNA were extracted for CMP.

Results 33 patients were randomized to 2(n=17) or 3(n=16) FNB passes. While sufficient DNA was extracted from all 33 cell blocks, adequate RNA was extracted from 93.8% in 3-pass vs. 94.1% in 2-pass cohort (p=0.99). There was no significant difference in mean DNA concentration (2-pass 10.7[SD 7.1] vs. 3-pass 7.9ng/ul[SD 4.4]; p=0.19) or RNA (2-pass 37.1[SD 26.5] vs. 3-pass 28.9ug/ul[SD 13.2]; p=0.29) between groups. While somatic oncogene RNA fusion (LDAH-ETV1) predictive of metastatic disease was identified in 1, DNA mutations were identified in all 33 pts (inc. 1 BRCA1 for Oxaliplatin based chemotherapy) ([Table 1]).

Table 1  

Conclusions Specimens of adequate quantity and of high quality for CMP in pancreatic cancer can be procured in nearly 95% of patients by performing 2 dedicated passes using 22G Franseen needle, adopting fanning maneuver and stylet-retraction technique.

 

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Conflicts of interest

Dr. Ji Young Bang is a Consultant for Boston Scientific Corporation and Olympus America Inc. Dr. Shyam Varadarajulu is a Consultant for Boston Scientific Corporation, Olympus America Inc. and Medtronic. Dr. Robert Hawes is a Consultant for Boston Scientific Corporation, Olympus America Inc., Medtronic and Cook Medical. Dr. Udayakumar Navaneethan is a Consultant for Janssen, Pfizer, Takeda, AbbVie, Bristol Myers Squibb and GIE Medical Inc.

Publication History

Article published online:
14 April 2023