KRAS Mutation In The Diagnosis Of Pancreatic Cystic Neoplasms:A Meta-analysis

Objective: to evaluate the diagnostic accuracy of KRAS mutation in pancreatic sac fluid.Methods: we identified the cystic fluid obtained by endoscopic ultrasound before surgery,and classified the cyst as malignant,precancerous and benign.The random effect model was used for Meta-analysis,and the sensitivity,specificity and the area under the working characteristic curve of the subjects were analyzed.Results: sixteen studies involving 731 patients were included in this study.In the diagnosis of malignant and clinically significant(including precancerous lesions and malignancies)cysts,the sensitivity of KRAS was0.44(95%CI,0.34~0.43)and 0.46(95%CI,0.42~0.51),the specificity was0.62(95%CI,0.56~0.68)and 0.99(95%CI,0.95~1.00),and the AUC was0.56 and 0.55,respectively.For clinically significant cysts,the sensitivity of was CEA 0.58(95% confidence interval,0.53~0.65),specificity was 0.9(95% confidence interval,0.76~0.97),and area under the operating characteristic curve(AUC)of subjects was 0.69.Cytological diagnosis of malignant cyst was effective,with sensitivity =0.37(95%CI 0.27~0.48),specificity =0.96(95%CI,0.93~0.98),and AUC=0.78.Conclusion: CEA and cytology are more accurate than KRAS,and there is a lack of routine studies to recommend KRAS as a single diagnostic test.