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Pflüger MJ, Jamouss KT, Afghani E, Lim SJ, Rodriguez Franco S, Mayo H, Spann M, Wang H, Singhi A, Lennon AM, Wood LD. Predictive ability of pancreatic cyst fluid biomarkers: A systematic review and meta-analysis. Pancreatology 2023; 23:868-877. [PMID: 37230894 DOI: 10.1016/j.pan.2023.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/10/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Mucinous pancreatic cysts harbor the potential to progress to highly lethal pancreatic ductal adenocarcinoma (PDAC). Since these precursor cysts require cancer surveillance or surgical resection, they need to be reliably distinguished from harmless pancreatic cysts. Current clinical and radiographic assessment is imperfect and the value of cyst fluid analysis for differential diagnosis is unclear. Therefore, we set out to investigate the value of cyst fluid biomarkers in distinguishing pancreatic cysts. METHODS We performed a systematic review of the current literature to identify articles that evaluated the diagnostic performance of clinically relevant and promising candidate cyst fluid biomarkers, with a particular emphasis on DNA-based biomarkers. Meta-analysis was performed for biomarkers targeted at identifying cyst type and presence of high-grade dysplasia or PDAC. RESULTS Data from a total of 42 studies was analyzed. Mutations in KRAS and/or GNAS allowed identification of mucinous cysts with a sensitivity of 79% and specificity of 98%. This exceeded the performance of the traditional biomarker carcinoembryonic antigen (CEA; sensitivity 58%, specificity 87%). Mutations in VHL were specific for serous cystadenomas (SCAs; sensitivity 56%, specificity 99%) and help to exclude mucinous cysts. Mutations in CDKN2A, PIK3CA, SMAD4, and TP53 each had high specificities of 97%, 97%, 98%, and 95%, respectively, to identify high-grade dysplasia or PDAC in mucinous cysts. CONCLUSIONS Cyst fluid analysis can be a valuable tool in the characterization of pancreatic cysts, with relevant clinical implications. Our results support the use of DNA-based cyst fluid biomarkers in the multidisciplinary diagnostic work-up of pancreatic cysts.
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Affiliation(s)
- Michael Johannes Pflüger
- Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Surgery CCM|CVK, Charité, Universitätsmedizin Berlin, Germany; Graduate School of Life Sciences, Utrecht University, The Netherlands
| | - Kevin Tony Jamouss
- Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elham Afghani
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA
| | - Su Jin Lim
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Harrison Mayo
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA
| | - Marcus Spann
- Johns Hopkins University School of Medicine, Welch Medical Library, Baltimore, MD, USA
| | - Hao Wang
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aatur Singhi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Anne Marie Lennon
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA.
| | - Laura D Wood
- Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Marín Serrano E, Duque Alcorta M. Diagnosis of a cystic pancreatic neuroendocrine tumor: is cystic fluid chromogranin A useful? REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:526-527. [PMID: 36454060 DOI: 10.17235/reed.2022.9366/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Cystic pancreatic neuroendocrine tumors (cP-NET) are a diagnostic challenge for clinic, since sometimes nor imaging features, cytology, or the study of biological markers in pancreatic cyst fluid (PCF), are able to provide the nature of the lesion, and therefore the definitive diagnostic is often made in the surgical piece. Is not infrequent that the lesions are wrongly defined as benign, in special when the cytology is negative for malignancy and the PCL is not mucinous and has a high glucose and a low CEA. We could incorporate new markers to improve the diagnostic performance of PCF samples, like chromogranin A, as in our case may be the only specific finding to detect a cP-TNE.
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3
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Zamir E, Zelnik Yovel D, Scapa E, Shnell M, Bar N, Bar Yishay I, Ziv-Baran T, Younis F, Phillips A, Lubezky N, Shibolet O, Ben-Ami Shor D. Pancreatic cyst fluid glucose: a rapid on-site diagnostic test for mucinous cysts. Therap Adv Gastroenterol 2022; 15:17562848221133581. [PMID: 36353735 PMCID: PMC9638530 DOI: 10.1177/17562848221133581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Pancreatic cystic fluid (PCF) analysis is frequently used for cyst diagnosis with carcinoembryonic antigen (CEA) being the most accepted biomarker. Low glucose levels in PCF were previously suggested as a marker for mucinous cysts. A bed-side glucometer is a point-of care, immediate, simple, and cheap method which requires a small volume of PCF. OBJECTIVES The aim of our study was to identify the optimal glucose cut-off level for identifying mucinous cysts, evaluate the diagnostic accuracy of glucose compared to CEA, and validate glucometry against reference laboratory biochemical analysis. DESIGN A single-center prospective cohort study. METHODS Consecutive patients aged 18 and older, who underwent pancreatic cyst evaluation, at the Tel Aviv Medical Center between 2016 and 2021 were analyzed. Cyst type was defined based on clinical, laboratory, and radiologic findings. Glucose was measured using laboratory biochemical analysis and two glucometers. Receiver operating characteristic analysis derived sensitivity, specificity, and accuracy were calculated and McNemar test was used to compare between methods. RESULTS One hundred and one PCF samples were evaluated. The areas under the receiver operating characteristics curve for identifying mucinous cysts using glucometer, glucose laboratory, and their combination were 0.88 (p < 0.001), 0.92 (p < 0.001), and 0.93 (p < 0.001), respectively. A glucose level of 87 mg/dL was identified as the optimal laboratory glucose threshold value to detect mucinous cyst with a sensitivity of 90.9%, specificity of 83.3%, and accuracy of 89.3, higher in comparison to cyst fluid CEA. Furthermore, PCF glucose levels had the strongest association with mucinous cysts. CONCLUSION Our findings suggest that PCF glucose level is more accurate than CEA for the diagnosis of mucinous cysts. Glucometry glucose level assessment demonstrated an excellent correlation with laboratory glucose measurements and may become a useful diagnostic test.
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Affiliation(s)
| | - Dana Zelnik Yovel
- Sackler Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel,The Kamila Gonczarowski Institute of
Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center,
Zerifin, Israel
| | - Erez Scapa
- Sackler Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel,Gastroenterology and Liver Disease, Tel Aviv
Sourasky Medical Center, Tel Aviv, Israel
| | - Mati Shnell
- Sackler Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel,Gastroenterology and Liver Disease, Tel Aviv
Sourasky Medical Center, Tel Aviv, Israel
| | - Nir Bar
- Sackler Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel,Gastroenterology and Liver Disease, Tel Aviv
Sourasky Medical Center, Tel Aviv, Israel
| | - Iddo Bar Yishay
- Sackler Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel,Gastroenterology and Liver Disease, Tel Aviv
Sourasky Medical Center, Tel Aviv, Israel
| | - Tomer Ziv-Baran
- School of Public Health, Sackler Faculty of
Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Fadi Younis
- Sackler Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel,Gastroenterology and Liver Disease, Tel Aviv
Sourasky Medical Center, Tel Aviv, Israel
| | - Adam Phillips
- Sackler Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel,Gastroenterology and Liver Disease, Tel Aviv
Sourasky Medical Center, Tel Aviv, Israel
| | - Nir Lubezky
- Sackler Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel,Unit of Liver Surgery, Department of Surgery,
Tel Aviv Medical Center, Tel Aviv, Israel
| | - Oren Shibolet
- Sackler Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel,Gastroenterology and Liver Disease, Tel Aviv
Sourasky Medical Center, Tel Aviv, Israel
| | - Dana Ben-Ami Shor
- Sackler Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel,Gastroenterology and Liver Disease, Tel Aviv
Sourasky Medical Center, Tel Aviv, Israel
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4
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Pancreatic Incidentaloma. J Clin Med 2022; 11:jcm11164648. [PMID: 36012893 PMCID: PMC9409921 DOI: 10.3390/jcm11164648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
Pancreatic incidentalomas (PIs) represent a clinical entity increasingly recognized due to advances in and easier access to imaging techniques. By definition, PIs should be detected during abdominal imaging performed for indications other than a pancreatic disease. They range from small cysts to invasive cancer. The incidental diagnosis of pancreatic cancer can contribute to early diagnosis and treatment. On the other hand, inadequate management of PIs may result in overtreatment and unneeded morbidity. Therefore, there is a strong need to evaluate the nature and clinical features of individual PIs. In this review, we summarize the major characteristics related to PIs and present suggestions for their management.
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Wietrzykowska-Grishanovich D, Pawlik E, Neubauer K. Biochemical Intracystic Biomarkers in the Differential Diagnosis of Pancreatic Cystic Lesions. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58080994. [PMID: 35893110 PMCID: PMC9331360 DOI: 10.3390/medicina58080994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Pancreatic cystic lesions (PCLs) are frequently incidental findings. The prevalence of PCLs is increasing, mainly due to advancements in imaging techniques, but also because of the aging of the population. PCLs comprise challenging clinical problems, as their manifestations vary from benign to malignant lesions. Therefore, the recognition of PCLs is achieved through a complex diagnostic and surveillance process, which in turn is usually long-term, invasive, and expensive. Despite the progress made in the identification of novel biomarkers in the cystic fluid that also support the differentiation of PCLs, their application in clinical practice is limited. Materials and Methods: We conducted a systematic review of the literature published in two databases, Pubmed and Embase, on biochemical biomarkers in PCLs that may be applied in the diagnostic algorithms of PCLs. Results: Eleven studies on intracystic glucose, twenty studies on intracystic carcinoembryonic antigen (CEA), and eighteen studies on other biomarkers were identified. Low levels of intracystic glucose had high sensitivity and specificity in the differentiation between mucinous and non-mucinous cystic neoplasms. Conclusions: CEA and glucose are the most widely studied fluid biochemical markers in pancreatic cystic lesions. Glucose has better diagnostic accuracy than CEA. Other biochemical biomarkers require further research.
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Affiliation(s)
- Dominika Wietrzykowska-Grishanovich
- Department of Gastroenterology and Hepatology, University Teaching Hospital, Borowska 213, 50-556 Wroclaw, Poland;
- Correspondence: (D.W.-G.); (K.N.)
| | - Ewa Pawlik
- Department of Gastroenterology and Hepatology, University Teaching Hospital, Borowska 213, 50-556 Wroclaw, Poland;
| | - Katarzyna Neubauer
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
- Correspondence: (D.W.-G.); (K.N.)
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Comparative analysis of glucose and carcinoembryonic antigen in the diagnosis of pancreatic mucinous cysts: a systematic review and meta-analysis. Gastrointest Endosc 2021; 94:235-247. [PMID: 33852901 DOI: 10.1016/j.gie.2021.03.935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Pancreatic cystic fluid (PCF) analysis is useful to distinguish between different cyst types and to guide management. The aim of our study was to compare the diagnostic accuracy of glucose level with carcinoembryonic antigen (CEA) in PCF for mucinous cyst diagnosis. METHODS We identified studies with PCF obtained by EUS before surgery, with cysts classified as mucinous and nonmucinous according to surgical specimens. A random-effects model was used for quantitative meta-analysis. Pooled sensitivities, specificities, and summary receiver operating characteristic (ROC) curve analysis were conducted. RESULTS For CEA, we included 31 studies with 5268 patients, of which 2083 were referred for surgery. For glucose, we included 4 studies with 345 patients, of which 275 were referred for surgery. Glucose performed better than CEA for mucinous cysts diagnosis (premalignant and malignant) with sensitivities of .90 (95% confidence interval [CI], .85-.94) and .67 (95% CI, .65-.70), specificities of .82 (95% CI, .72-.89) and .80 (95% CI, 0.76-0.83), and areas under the ROC curve of .96 and .79, respectively. Glucose had a higher sensitivity (90%), with uncommon false-negative results, making it an excellent biomarker to exclude a mucinous cyst. Sensitivity analysis demonstrated that the findings of the current meta-analysis are robust. CONCLUSION Glucose level in PCF is more accurate than CEA for preoperative diagnosis of mucinous cysts. It may become a useful first-line test, particularly in small cysts with a limited volume of PCF. Larger studies are awaited to confirm glucose as the single test for mucinous cyst diagnosis.
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Faias S, Prazeres S, Cunha M, Pereira L, Roque R, Chaves P, Cravo M, Claro I, Silveira M, Leite V, Dias Pereira A. Chromogranin A and NSE in cystic pancreatic neuroendocrine tumors. Clin Res Hepatol Gastroenterol 2021; 45:101601. [PMID: 33386244 DOI: 10.1016/j.clinre.2020.101601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/25/2020] [Accepted: 12/07/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Sandra Faias
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, EPE, Lisboa, Portugal; Faculty of Health Sciences, Universidade da Beira Interior, Covilhã, Portugal.
| | - Susana Prazeres
- Clinical Pathology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, EPE, Lisboa, Portugal.
| | - Mario Cunha
- Clinical Pathology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, EPE, Lisboa, Portugal.
| | - Luisa Pereira
- Center of Mathmatics and Applications (CMA-UBI), Universidade da Beira Interior, Covilhã, Portugal.
| | - Ruben Roque
- Pathology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, EPE, Lisboa, Portugal.
| | - Paula Chaves
- Pathology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, EPE, Lisboa, Portugal.
| | - Marília Cravo
- Gastroenterology Department, Hospital Beatriz Ângelo, Loures, Portugal; Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
| | - Isabel Claro
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, EPE, Lisboa, Portugal.
| | - Margarida Silveira
- Clinical Pathology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, EPE, Lisboa, Portugal.
| | - Valeriano Leite
- Endocrinology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, EPE, Lisboa, Portugal; Faculty of Medical Sciences of Lisbon, Lisboa, Portugal.
| | - A Dias Pereira
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, EPE, Lisboa, Portugal.
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Stigliano S, Zaccari P, Severi C. Pancreatic intra-cystic CA 19-9 dosage in the management of pancreatic cysts: Useful or confounding? Dig Liver Dis 2021; 53:131-133. [PMID: 33172808 DOI: 10.1016/j.dld.2020.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Serena Stigliano
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.
| | - Piera Zaccari
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Carola Severi
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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Hermoso-Durán S, García-Rayado G, Ceballos-Laita L, Sostres C, Vega S, Millastre J, Sánchez-Gracia O, Ojeda JL, Lanas Á, Velázquez-Campoy A, Abian O. Thermal Liquid Biopsy (TLB) Focused on Benign and Premalignant Pancreatic Cyst Diagnosis. J Pers Med 2020; 11:jpm11010025. [PMID: 33396529 PMCID: PMC7823923 DOI: 10.3390/jpm11010025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023] Open
Abstract
Background: Current efforts in the identification of new biomarkers are directed towards an accurate differentiation between benign and premalignant cysts. Thermal Liquid Biopsy (TLB) has been previously applied to inflammatory and tumor diseases and could offer an interesting point of view in this type of pathology. Methods: In this work, twenty patients (12 males and 8 females, average ages 62) diagnosed with a pancreatic cyst benign (10) and premalignant (10) cyst lesions were recruited, and biological samples were obtained during the endoscopic ultrasonography procedure. Results: Proteomic content of cyst liquid samples was studied and several common proteins in the different groups were identified. TLB cyst liquid profiles reflected protein content. Also, TLB serum score was able to discriminate between healthy and cysts patients (71% sensitivity and 98% specificity) and between benign and premalignant cysts (75% sensitivity and 67% specificity). Conclusions: TLB analysis of plasmatic serum sample, a quick, simple and non-invasive technique that can be easily implemented, reports valuable information on the observed pancreatic lesion. These preliminary results set the basis for a larger study to refine TLB serum score and move closer to the clinical application of TLB providing useful information to the gastroenterologist during patient diagnosis.
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Affiliation(s)
- Sonia Hermoso-Durán
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (S.H.-D.); (G.G.-R.); (L.C.-L.); (C.S.); (J.M.); (Á.L.)
- Joint Units IQFR-CSIC-BIFI, and GBsC-CSIC-BIFI, Institute of Biocomputation and Physics of Complex Systems (BIFI), Universidad de Zaragoza, 50018 Zaragoza, Spain;
| | - Guillermo García-Rayado
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (S.H.-D.); (G.G.-R.); (L.C.-L.); (C.S.); (J.M.); (Á.L.)
- Servicio de Digestivo, Hospital Clínico Universitario Lozano Blesa (HCULB), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red en el Área Temática de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Laura Ceballos-Laita
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (S.H.-D.); (G.G.-R.); (L.C.-L.); (C.S.); (J.M.); (Á.L.)
- Joint Units IQFR-CSIC-BIFI, and GBsC-CSIC-BIFI, Institute of Biocomputation and Physics of Complex Systems (BIFI), Universidad de Zaragoza, 50018 Zaragoza, Spain;
| | - Carlos Sostres
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (S.H.-D.); (G.G.-R.); (L.C.-L.); (C.S.); (J.M.); (Á.L.)
- Servicio de Digestivo, Hospital Clínico Universitario Lozano Blesa (HCULB), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red en el Área Temática de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Sonia Vega
- Joint Units IQFR-CSIC-BIFI, and GBsC-CSIC-BIFI, Institute of Biocomputation and Physics of Complex Systems (BIFI), Universidad de Zaragoza, 50018 Zaragoza, Spain;
| | - Judith Millastre
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (S.H.-D.); (G.G.-R.); (L.C.-L.); (C.S.); (J.M.); (Á.L.)
- Servicio de Digestivo, Hospital Clínico Universitario Lozano Blesa (HCULB), 50009 Zaragoza, Spain
| | | | - Jorge L. Ojeda
- Department of Statistical Methods, Universidad de Zaragoza, 50009 Zaragoza, Spain;
| | - Ángel Lanas
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (S.H.-D.); (G.G.-R.); (L.C.-L.); (C.S.); (J.M.); (Á.L.)
- Servicio de Digestivo, Hospital Clínico Universitario Lozano Blesa (HCULB), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red en el Área Temática de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
- Department of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Adrián Velázquez-Campoy
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (S.H.-D.); (G.G.-R.); (L.C.-L.); (C.S.); (J.M.); (Á.L.)
- Joint Units IQFR-CSIC-BIFI, and GBsC-CSIC-BIFI, Institute of Biocomputation and Physics of Complex Systems (BIFI), Universidad de Zaragoza, 50018 Zaragoza, Spain;
- Centro de Investigación Biomédica en Red en el Área Temática de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
- Fundación ARAID, Gobierno de Aragón, 50009 Zaragoza, Spain
- Departamento de Bioquímica y Biología Molecular y Celular, Universidad de Zaragoza, 50009 Zaragoza, Spain
- Correspondence: (A.V.-C.); (O.A.); Tel.: +34-976-762996 (A.V.-C.); +34-876-555417 (O.A.)
| | - Olga Abian
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (S.H.-D.); (G.G.-R.); (L.C.-L.); (C.S.); (J.M.); (Á.L.)
- Joint Units IQFR-CSIC-BIFI, and GBsC-CSIC-BIFI, Institute of Biocomputation and Physics of Complex Systems (BIFI), Universidad de Zaragoza, 50018 Zaragoza, Spain;
- Centro de Investigación Biomédica en Red en el Área Temática de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
- Fundación ARAID, Gobierno de Aragón, 50009 Zaragoza, Spain
- Instituto Aragonés de Ciencias de la Salud (IACS), 50009 Zaragoza, Spain
- Correspondence: (A.V.-C.); (O.A.); Tel.: +34-976-762996 (A.V.-C.); +34-876-555417 (O.A.)
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10
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Faias S, Pereira L, Roque R, Chaves P, Torres J, Cravo M, Pereira AD. Excellent Accuracy of Glucose Level in Cystic Fluid for Diagnosis of Pancreatic Mucinous Cysts. Dig Dis Sci 2020; 65:2071-2078. [PMID: 31705344 DOI: 10.1007/s10620-019-05936-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/02/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND CEA in pancreatic cystic fluid (PCF) is standard for mucinous cysts diagnosis. Glucose is an alternative, but its accuracy remains poorly described. AIMS To evaluate PCF glucose using a glucometer and compare its accuracy with CEA for mucinous cysts diagnosis. MATERIALS AND METHODS In frozen PCF obtained by EUS-FNA, glucose was evaluated using a glucometer. CEA and cytology were available as standard of care. The accuracy of glucose and CEA was calculated using receiver operator (ROC) curves. Definitive diagnoses were surgical or clinicopathological. RESULTS We evaluated 82 patients with a mean age of 61.3 ± 14.8 years (25-91), predominantly (59%) females. Diagnoses included 17 serous cystadenomas, five pseudocysts, 20 intraductal papillary mucinous neoplasms, three mucinous cystic neoplasms, five adenocarcinomas, four neuroendocrine tumors, two other types, 26 non-defined. The median glucose levels (interquartile range) were 19 mg/dL (19-19) in mucinous and 105 mg/dL (96-127) in non-mucinous cysts (p < 0.0001). The median CEA level was 741 ng/mL (165-28,567) in mucinous and 9 ng/mL (5-19) in non-mucinous cysts (p < 0.0001). For mucinous cyst diagnosis, a CEA > 192 ng/mL had a sensitivity of 72% (95% CI 51-88) and a specificity of 96% (95% CI 82-100), and ROC analysis showed an area under the curve (AUC) of 0.842 (95% CI 0.726-0.959), while glucose < 50 mg/dL had a sensitivity of 89% (95% CI 72-98), a specificity of 86% (95% CI 67-96), and an AUC of 0.86 (95% CI 0.748-0.973). Pseudocysts presented low glucose, identically to mucinous cysts, with CEA allowing differential diagnosis. CONCLUSION Glucose measured by a glucometer is accurate for mucinous cyst diagnosis, with significantly higher levels in non-mucinous cysts, except pseudocysts.
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Affiliation(s)
- Sandra Faias
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Rua Prof Lima Basto, 1099-023, Lisbon, Portugal. .,Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.
| | - Luisa Pereira
- Center of Mathematics and Applications (CMA-UBI), University of Beira Interior, Av. Infante D. Henrique, 6200-506, Covilhã, Portugal
| | - Ruben Roque
- Pathology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Rua Prof Lima Basto, 1099-023, Lisbon, Portugal
| | - Paula Chaves
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,Pathology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Rua Prof Lima Basto, 1099-023, Lisbon, Portugal
| | - Joana Torres
- Gastroenterology Department, Hospital Beatriz Ângelo, Av. Carlos Teixeira, 3, 2670-000, Loures, Portugal
| | - Marília Cravo
- Gastroenterology Department, Hospital Beatriz Ângelo, Av. Carlos Teixeira, 3, 2670-000, Loures, Portugal.,Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - A Dias Pereira
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Rua Prof Lima Basto, 1099-023, Lisbon, Portugal
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Management of Incidental Pancreatic Cystic Lesions: Integrating Novel Diagnostic and Prognostic Factors With Current Clinical Guidelines. J Clin Gastroenterol 2020; 54:415-427. [PMID: 32011401 DOI: 10.1097/mcg.0000000000001310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Owing to increased detection rates, the diagnosis and management of incidental pancreatic cysts has become a common predicament. Up to 13% of patients undergoing cross-sectional imaging studies for other indications are found to have pancreatic cystic lesions. Although most cystic lesions are benign, the malignant potential of several types of pancreatic cysts makes accurate classification vital to directing therapy. To this end, advances in the last decade led to better characterization of pancreatic cyst morphology and hence enhanced the ability to predict underlying histopathology, and biological behavior. Although accurate classification remains a challenge, the utilization of complementary diagnostic tools is the optimal approach to dictate management. The following review includes a description of pancreatic cysts, a critical review of current and emerging diagnostic techniques and a review of recent guidelines in the management of incidental pancreatic cysts.
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