Cyst Fluid Glucose is Rapidly Feasible and Accurate in Diagnosing Mucinous Pancreatic Cysts

Abstract

Glucose, whether measured by a laboratory assay, a glucometer, or a reagent strip, is significantly lower in mucinous cysts compared with non-mucinous pancreatic cysts.

Pancreatic cyst fluid glucose: rapid, inexpensive, and accurate diagnosis of mucinous pancreatic cysts

“…We hypothesize that an alternate cyst fluid biomarker may offer improved diagnostic accuracy and efficiency over the standard CEA test for determination of mucinous versus nonmucinous cysts. Two previous studies from a single institution reported the potential of pancreatic cyst fluid glucose for the diagnosis of mucinous cysts 9,10 . The studies included 45 and 65 patient samples and found sensitivities and specificities ranging from 81-95% and 57-78% for detection of mucinous pancreatic cysts using thresholds of <66 and 50 mg/dL, respectively.…”

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

“…However, studies have shown that cyst fluid amylase levels are similar in IPMNs and MCNs, and thus cannot be used to differentiate these two types of cysts [27]. There has been an interest in using cyst fluid glucose levels to differentiate IPMNs and MCNs from other types of cysts [28,29]. A recent study evaluated this in 153 patients all of whom had undergone surgical resection [30].…”

Utility of endoscopic ultrasound and endoscopic ultrasound‐guided fine‐needle aspiration for the diagnosis and management of pancreatic cystic lesions: Differences between the guidelines

“…Aspirated cyst fluid occasionally does not contain enough PCL cellular material. A meta-analysis of EUS-FNA for diagnosing PCL, including 18 studies and a total of 1438 patients, showed a pooled sensitivity and specificity of cytological diagnostic capability for differentiating mucinous from non-mucinous cysts as 54% (95% CI, [49][50][51][52][53][54][55][56][57][58][59] and 93% (95% CI, 90-95), respectively. 40 A recent systematic review for the detection of malignant IPMN, including 193 studies with 12,297 patients, showed cyst fluid cytology as area under the curve of 0.84, sensitivity of 54% and specificity of 91% to identify malignant IPMN.…”

“…More recently, next-generation sequencing (NGS) of DNA, miRNA, and proteomic and metabolomic approaches were evaluated to identify possible biomarkers in cyst fluid in the hopes of improving the diagnostic capability of PCL. [53][54][55][56][57][58] A study by Singhi et al 57 prospectively and preoperatively evaluated NGS of cyst fluid obtained by EUS-FNA from PCL and also determined the accuracy of molecular analysis using both NGS and Sanger sequencing. Based on 102 patients with surgical follow up, KRAS/GNAS mutations on NGS were detected in 56 (100%) IPMN and in three (30%) MCN, and associated with 89% sensitivity and 100% specificity for mucinous cystic lesions compared with 65% sensitivity and 100% specificity with KRAS/GNAS mutations by Sanger sequencing.…”