Copyright
©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
New era for pancreatic endoscopic ultrasound: From imaging to molecular pathology of pancreatic cancer
Livia Archibugi, Sabrina Gloria Giulia Testoni, Miriam Redegalli, Maria Chiara Petrone, Michele Reni, Massimo Falconi, Claudio Doglioni, Gabriele Capurso, Paolo Giorgio Arcidiacono
Livia Archibugi, Sabrina Gloria Giulia Testoni, Maria Chiara Petrone, Gabriele Capurso, Paolo Giorgio Arcidiacono, Pancreato-Biliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
Miriam Redegalli, Claudio Doglioni, Pathology Department, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
Michele Reni, Department of Medical Oncology, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
Massimo Falconi, Pancreatic Surgery Department, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
Author contributions: Archibugi L and Testoni SGG contributed equally to the paper and share first authorship; Archibugi L, Testoni SGG, and Redegalli M performed the literature search and drafted the manuscript; Petrone MC, Doglioni C, Capurso G, and Arcidiacono PG critically revised the manuscript; Capurso G, Reni M, Falconi M, Doglioni C, Petrone MC, and Arcidiacono PG provided scientific guidance; all authors revised and approved the final version of this article.
Supported by Associazione Italiana Ricerca sul Cancro (AIRC), No. IG 17177
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Gabriele Capurso, MD, PhD, Chief Doctor, Pancreato-Biliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy.
capurso.gabriele@hsr.it
Telephone: +39-02-26436548 Fax: +39-02-26435607
Received: June 15, 2019
Peer-review started: June 19, 2019
First decision: July 31, 2019
Revised: August 1, 2019
Accepted: August 20, 2019
Article in press: August 21, 2019
Published online: November 15, 2019
Processing time: 154 Days and 22.2 Hours
With recent advances in molecular pathology and the development of new chemotherapy regimens, the knowledge of the molecular alterations of pancreatic ductal adenocarcinoma (PDAC) is becoming appealing for stratifying patients for prognosis and response to a defined treatment. Archival formalin-fixed, paraffin-embedded samples are a useful source of genomic deoxyribonucleic acid; nevertheless, most studies employed formalin-fixed, paraffin-embedded samples deriving from surgical specimens, which are therefore representative of <20% of PDAC patients. Indeed, the development of a reliable methodology for endoscopic ultrasound-guided tissue acquisition, stabilization, and analysis is crucial for the development of molecular markers for clinical use in order to achieve “personalized medicine”. With the development of new needles, this technique is able to retrieve a high quantity and quality of PDAC tissue that can be used not only for diagnosis but also for mutational and transcriptome evaluations and for the development of primary cell or tissue cultures. In the present editorial, we discuss the current knowledge regarding the use of endoscopic ultrasound as a tool to obtain samples for molecular analyses, its possible pitfalls, and its use for the development of disease models such as xenografts or organoids.
Core tip: Surgical formalin-fixed, paraffin-embedded samples are not representative of all pancreatic ductal adenocarcinoma patients and it has been proven that “pre-resection” fine-needle aspiration smears are a better DNA source. Therefore, endoscopic ultrasound (EUS) is the recommended method for obtaining a tumor’s molecular signature. However, important limitations of EUS-acquired samples are: Intratumoral heterogeneity, total amount of tumoral cells, and lesional-to-non-lesional cell ratio. Furthermore, sample handling and storage conditions might affect the efficiency of DNA and even more RNA extraction. The possibility to obtain sufficient material from EUS to generate patient-derived xenografts or organoids is also a “hot topic”. Thus, optimization and standardization of procedures for EUS-guided biopsy and molecular analyses are essential to allow “precision medicine” for pancreatic ductal adenocarcinoma.
