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@ARTICLE{Schmitz:303495,
      author       = {D. Schmitz and S. Prax and M. Kliment and F. Gocke and D.
                      Kazdal and M. Allgäuer and R. Penzel and M. Kirchner and O.
                      Neumann and H. Sültmann$^*$ and J. Budczies and P.
                      Schirmacher$^*$ and F. Bergmann and J.-P. Ritz and R. Hinze
                      and F. Grassmann and J. Rudi and A. Stenzinger and A.-L.
                      Volckmar},
      title        = {{D}ifferentiating {M}ain-{D}uct {IPMN} from {C}hronic
                      {P}ancreatitis {U}sing {N}ext-{G}eneration {S}equencing of
                      {M}ain {P}ancreatic {D}uct {F}luid: {A} {P}ilot {S}tudy.},
      journal      = {Diagnostics},
      volume       = {15},
      number       = {15},
      issn         = {2075-4418},
      address      = {Basel},
      publisher    = {MDPI},
      reportid     = {DKFZ-2025-01686},
      pages        = {1964},
      year         = {2025},
      abstract     = {Background: A dilated main pancreatic duct (MPD) ≥ 5 mm
                      can be observed in main-duct IPMNs (MD-IPMN) and chronic
                      pancreatitis (CP); however, distinguishing between the two
                      differently treated diseases can be difficult. Cell-free
                      (cf) DNA in MPD fluid obtained by EUS-guided FNA might help
                      to distinguish MD-IPMN from CP. Methods: All patients with a
                      dilated MPD ≥ 5 mm on EUS during the period of 1 June 2017
                      to 30 April 2024 were prospectively analysed in this
                      single-centre study, with EUS-guided MPD fluid aspiration
                      performed for suspected MD-IPMN or CP in patients who were
                      suitable for surgery. Twenty-two known gastrointestinal
                      cancer genes, including GNAS and KRAS, were analysed by deep
                      targeted (dt) NGS. The results were correlated with resected
                      tissue, biopsy, and long-term follow-up. Results: A total of
                      164 patients with a dilated MPD were identified, of which 30
                      $(18.3\%)$ underwent EUS-guided FNA, with 1 patient having a
                      minor complication $(3.3\%).$ Twenty-two patients (mean MPD
                      diameter of 12.4 (7-31) mm) with a definitive, mostly
                      surgically confirmed diagnosis were included in the
                      analysis. Only a fish-mouth papilla, which was present in 3
                      of 12 $(25\%)$ MD-IPMNs, could reliably differentiate
                      between the two diseases, with history, symptoms, diffuse or
                      segmental MPD dilation, presence of calcifications on
                      imaging, cytology, and CEA in the ductal fluid failing to
                      achieve differentiation. However, GNAS mutations were found
                      exclusively in 11 of the 12 $(91.6\%)$ patients with MD-IPMN
                      (p < 0.01), whereas KRAS mutations were identified in both
                      diseases. Conclusions: GNAS testing by dtNGS in aspirated
                      fluid from dilated MPD obtained by EUS-guided FNA may help
                      differentiate MD-IPMN from CP for surgical resection.},
      keywords     = {chronic (Other) / endoscopic ultrasound-guided fine needle
                      aspiration (Other) / high-throughput nucleotide sequencing
                      (Other) / intraductal papillary mucinous neoplasm (Other) /
                      pancreatitis (Other) / prospective study (Other)},
      cin          = {B063},
      ddc          = {610},
      cid          = {I:(DE-He78)B063-20160331},
      pnm          = {312 - Funktionelle und strukturelle Genomforschung
                      (POF4-312)},
      pid          = {G:(DE-HGF)POF4-312},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40804928},
      doi          = {10.3390/diagnostics15151964},
      url          = {https://inrepo02.dkfz.de/record/303495},
}