A Pilot Study to Evaluate Tissue- and Plasma-based DNA Driver Mutations in a Cohort of Patients with Pancreatic Intraductal Papillary Mucinous Neoplasms.

Intraductal papillary mucinous neoplasms (IPMNs) are precursor lesions to pancreatic ductal adenocarcinoma (PDAC) that are challenging to manage due to limited imaging, cytologic, and molecular markers that accurately classify lesions, grade of dysplasia, or focus of invasion preoperatively. The objective of this pilot study was to determine the frequency and type of DNA mutations in a cohort of surgically resected, pathologically confirmed IPMN, and to determine if concordant mutations are detectable in paired pre-treatment plasma samples. Formalin-fixed paraffin embedded (FFPE) tissue from 46 surgically resected IPMNs (31 low -grade, 15high-grade) and paired plasma from a subset of fifteen IPMN cases (10 -low-grade, 5 high-grade) were subjected to targeted mutation analysis using a QIAseq Targeted DNA Custom Panel. Common driver mutations were detected in FFPE from 44 of 46 (95.6%) IPMN cases spanning all grades; the most common DNA mutations included: KRAS (80%), RNF43 (24%), and GNAS (43%). Of note, we observed a significant increase in the frequency of RNF43 mutations from low-grade to high-grade to high-grade IPMNs associated or concomitant with invasive carcinoma (trend test, p = 0.01). Among the subset of cases with paired plasma, driver mutations identified in the IPMNs were not detected in circulation. Overall, our results indicate that mutational burden for IPMNs are a common occurrence, even in low-grade IPMNs. Furthermore, although blood-based biopsies are an attractive, non-invasive method for detecting somatic DNA mutations, the QIAseq panel was not sensitive enough to detect driver mutations that existed in IPMN tissue using paired plasma in the volume we were able to retrieve for this retrospective study.