Analysis of Pancreatic Cyst Fluid

Abstract

Synopsis Pancreatic cysts are extremely common, and are identified in between 2% to 13% on abdominal imaging studies. The majority of pancreatic cysts are pseudocysts, serous cystic neoplasms (SCNs), mucinous cystic neoplasms (MCNs) or intraductal papillary mucinous neoplasm (IPMNs). The management of pancreatic cysts depends on whether a cyst is benign, has malignant potential, or harbors high-grade dysplasia or invasive carcinoma. The diagnosis of pancreatic cysts, and assessment of risk of malignant transformation, incorporates a number of factors including clinical history, computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasound and fine needle aspiration of cyst fluid (EUS-FNA). This paper reviews the cyst fluid markers which are currently used, as well as promising markers under development.

Cyst Fluid Biomarkers - Diagnosis and Prediction of Malignancy for Cystic Lesions of the Pancreas

“…Low amylase levels can be useful in excluding a pseudocyst, as shown in a large meta-analysis which found that a cyst fluid amylase level of <250 IU/l had a very high specificity (98%) for excluding a pseudocyst [25]. In contrast, a high cyst fluid amylase level is not helpful, as it is found in multiple types of pancreatic cysts including SCAs, IPMNs, and MCNs [26]. Some authors have hypothesized that IPMNs, which have a communication between the main pancreatic duct and the cyst, would have a high cyst fluid amylase level, whereas MCNs, which have no connection with the main pancreatic duct, should have a low amylase level.…”

Endoscopic ultrasound‐through‐the‐needle biopsy in pancreatic cystic lesions: A multicenter study

“…Carcinoembryonic antigen (CEA) cystic fluid levels have limited accuracy and are not useful to confirm or rule out the presence of malignancy . Although molecular analyses are considered to be very promising, a truly accurate and reliable marker has yet to be identified.…”

“…Although molecular analyses are considered to be very promising, a truly accurate and reliable marker has yet to be identified. Data on the use of needle‐based confocal laser endomicroscopy (CLE) are promising, even if better interobserver agreement and validation are needed …”

“…[4][5][6][7][8] Carcinoembryonic antigen (CEA) cystic fluid levels have limited accuracy and are not useful to confirm or rule out the presence of malignancy. 9 Although molecular analyses are considered to be very promising, a truly accurate and reliable marker has yet to be identified. Data on the use of needlebased confocal laser endomicroscopy (CLE) are promising, even if better interobserver agreement and validation are needed.…”

Detection and management of retroperitoneal cystic lesions: A case report and review of the literature

“…These lesions collect pancreatic secretions, including pancreatic amylases and lipases. The identification of these enzymes inside the cysts allows an easy diagnosis (87). The lesions commonly originate as extensions from the diseased pancreas, but could also migrate to different sites of the retroperitoneal space (88).…”