A Review of the Diagnosis and Management of Premalignant Pancreatic Cystic Lesions

Keane, M. G.; Afghani, Elham

doi:10.3390/jcm10061284

Cited by 39 publications

(36 citation statements)

References 153 publications

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“…Although cross-sectional imaging and EUS are considered the gold standard to detect, worrisome features of malignancy in IPMN, several biomarkers have been described as useful tools in daily practice. Carbohydrate Antigen 19-9 and Carcinoembryonic Antigen (CEA) are the most frequently used biomarkers during the follow-up [ 10 ]. Laboratory scores such as Neutrophil to lymphocyte ratio (NLR), Platelet to lymphocyte ratio (PLR), and C-reactive protein to albumin ratio (CAR) have been reported as potential predictors of malignancy in IPMN.…”

Section: Introductionmentioning

confidence: 99%

Humoral Predictors of Malignancy in IPMN: A Review of the Literature

Nista

Schepis

Candelli

et al. 2021

IJMS

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Pancreatic cystic lesions are increasingly detected in cross-sectional imaging. Intraductal papillary mucinous neoplasm (IPMN) is a mucin-producing subtype of the pancreatic cyst lesions arising from the pancreatic duct system. IPMN is a potential precursor of pancreatic cancer. The transformation of IPMN in pancreatic cancer is progressive and requires the occurrence of low-grade dysplasia, high-grade dysplasia, and ultimately invasive cancer. Jaundice, enhancing mural nodule >5 mm, main pancreatic duct diameter >10 mm, and positive cytology for high-grade dysplasia are considered high-risk stigmata of malignancy. While increased levels of carbohydrate antigen 19-9 (CA 19-9) (>37 U/mL), main pancreatic duct diameter 5–9.9 mm, cyst diameter >40 mm, enhancing mural nodules <5 mm, IPMN-induced acute pancreatitis, new onset of diabetes, cyst grow-rate >5 mm/year are considered worrisome features of malignancy. However, cross-sectional imaging is often inadequate in the prediction of high-grade dysplasia and invasive cancer. Several studies evaluated the role of humoral and intra-cystic biomarkers in the prediction of malignancy in IPMN. Carcinoembryonic antigen (CEA), CA 19-9, intra-cystic CEA, intra-cystic glucose, and cystic fluid cytology are widely used in clinical practice to distinguish between mucinous and non-mucinous cysts and to predict the presence of invasive cancer. Other biomarkers such as cystic fluid DNA sequencing, microRNA (mi-RNA), circulating microvesicles, and liquid biopsy are the new options for the mini-invasive diagnosis of degenerated IPMN. The aim of this study is to review the literature to assess the role of humoral and intracystic biomarkers in the prediction of advanced IPMN with high-grade dysplasia or invasive carcinoma.

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Section: Introductionmentioning

confidence: 99%

Humoral Predictors of Malignancy in IPMN: A Review of the Literature

Nista

Schepis

Candelli

et al. 2021

IJMS

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“…Furthermore, up to 11% of radiographic low-risk classified pancreatic lesions that underwent surgery were afterwards histologically confirmed as malignant lesions [ 17 ]. On the other hand, the risk of surgical overtherapy in patients with IPMN or mucinous cystadenomas (MCN) is high, and guidelines for the management of precursor lesions of pancreatic cancer are inconsistent [ 18 ]. Therefore, the development of new non-invasive biomarkers is crucial to improve early diagnosis and surveillance of precursor lesions of PDAC to aid surgical decision making.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Biomarkers in Pancreatic Ductal Adenocarcinoma on Diagnosis, Surveillance and Therapy

Sturm

Ettrich

Perkhofer

2022

Cancers

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Pancreatic ductal adenocarcinoma (PDAC) is still difficult to treat due to insufficient methods for early diagnosis and prediction of therapy response. Furthermore, surveillance after curatively intended surgery lacks adequate methods for timely detection of recurrence. Therefore, several molecules have been analyzed as predictors of recurrence or early detection of PDAC. Enhanced understanding of molecular tumorigenesis and treatment response triggered the identification of novel biomarkers as predictors for response to conventional chemotherapy or targeted therapy. In conclusion, progress has been made especially in the prediction of therapy response with biomarkers. The use of molecules for early detection and recurrence of PDAC is still at an early stage, but there are promising approaches in noninvasive biomarkers, composite panels and scores that can already ameliorate the current clinical practice. The present review summarizes the current state of research on biomarkers for diagnosis and therapy of pancreatic cancer.

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“…These are recognized a distinct entity apart from IPMNs since the 2019 WHO classification of tumors of the digestive system [12], and will not be discussed hereafter. These lesions have the potential for malignant transformation, justifying surveillance protocols and, in some cases, surgical resection, the modalities and indications of which have been reviewed elsewhere [13].…”

Section: Introductionmentioning

confidence: 99%

Intraductal Papillary Mucinous Carcinoma Versus Conventional Pancreatic Ductal Adenocarcinoma: A Comprehensive Review of Clinical-Pathological Features, Outcomes, and Molecular Insights

Mas

Lupinacci

Cros

et al. 2021

IJMS

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Intraductal papillary mucinous neoplasms (IPMN) are common and one of the main precursor lesions of pancreatic ductal adenocarcinoma (PDAC). PDAC derived from an IPMN is called intraductal papillary mucinous carcinoma (IPMC) and defines a subgroup of patients with ill-defined specificities. As compared to conventional PDAC, IPMCs have been associated to clinical particularities and favorable pathological features, as well as debated outcomes. However, IPMNs and IPMCs include distinct subtypes of precursor (gastric, pancreato-biliary, intestinal) and invasive (tubular, colloid) lesions, also associated to specific characteristics. Notably, consistent data have shown intestinal IPMNs and associated colloid carcinomas, defining the “intestinal pathway”, to be associated with less aggressive features. Genomic specificities have also been uncovered, such as mutations of the GNAS gene, and recent data provide more insights into the mechanisms involved in IPMCs carcinogenesis. This review synthetizes available data on clinical-pathological features and outcomes associated with IPMCs and their subtypes. We also describe known genomic hallmarks of these lesions and summarize the latest data about molecular processes involved in IPMNs initiation and progression to IPMCs. Finally, potential implications for clinical practice and future research strategies are discussed.

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A Review of the Diagnosis and Management of Premalignant Pancreatic Cystic Lesions

Cited by 39 publications

References 153 publications

Humoral Predictors of Malignancy in IPMN: A Review of the Literature

Humoral Predictors of Malignancy in IPMN: A Review of the Literature

The Impact of Biomarkers in Pancreatic Ductal Adenocarcinoma on Diagnosis, Surveillance and Therapy

Intraductal Papillary Mucinous Carcinoma Versus Conventional Pancreatic Ductal Adenocarcinoma: A Comprehensive Review of Clinical-Pathological Features, Outcomes, and Molecular Insights

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