Differential diagnosis of pancreatic cysts: A prospective study on the role of intra-cystic glucose concentration

Abstract

Background: The accuracy and costs of current diagnostic methods in the differential diagnosis of pancreatic cystic lesions still has ample room for improvement. Aims:The aim of the study was to confirm the diagnostic yield of intracystic glucose in the diagnosis of pancreatic cyst subtypes. Methods:We prospectively recruited all patients who underwent Endoscopic Ultrasound with Fine Needle Aspiration of pancreatic cyst at our Institution.Results: Fifty-six patients were included in the study. We found that intracystic glucose concentration < 50 mg/dL was significantly more sensitive than a concentration of Carcinoembryonic Antigen > 192 ng/mL (93.6% vs 54.8%; p = 0.003) for the diagnosis of mucinous cysts. In terms of specificity, the two markers were not different (96% vs 100%; p = 1). Regarding the diagnosis of nonmucinous cysts, intracystic glucose concentration ≥ 50 mg/mL showed higher sensitivity than Carcinoembryonic Antigen level < 5 ng/mL (96% vs 72%) although a statistical significance could not be reached (p=0.07). The two markers were not statistically different in terms of specificity (93.6% vs 87.1%; p = 0.62). Conclusion:Given its diagnostic performance and ease of measurement, intracystic glucose may replace Carcinoembryonic Antigen in the differential diagnosis of mucinous versus non-mucinous pancreatic cysts.

Familial Gullo’s Syndrome: a clinical case report

“…They are heterogeneous and include malignant, benign, and pre-malignant lesions, capable of evolving into invasive carcinoma over time. The differential diagnosis between intraductal papillary mucinous neoplasm, mucinous cystoadenoma and serous cystoadenoma could be made by endoscopic ultrasonography fine needle aspiration or even better with endoscopic ultrasonography through-theneedle microforceps biopsy [25], with the determination of intracystic glucose concentration, having been found to be more sensitive than the concentration of carcinoembryonic antigen [24]; however, this investigation is not carried out in our hospital.…”

“…In adulthood, the prevalence of incidentally found pancreatic cystic lesions is high (between 2.6% and 19.6%) [21][22][23][24]. They are heterogeneous and include malignant, benign, and pre-malignant lesions, capable of evolving into invasive carcinoma over time.…”

State-of-the-Art Update of Pancreatic Cysts

“…A recent meta-analysis reported 91% sensitivity and 75% specificity for glucose compared with 67% sensitivity and 80% specificity for CEA [51]. The most common cutoff of less than 50 mg/dl suggests mucinous cysts with sensitivity ranging from 89 to 92% and specificity 75% to 86% [52][53][54][55]. Pseudocysts were also noted to have low glucose levels [53].…”

Application of EUS-based techniques in the evaluation of pancreatic cystic neoplasms

“…Later, several studies demonstrated that cyst fluid glucose level performs better than CEA in differentiating mucinous from nonmucinous cysts. [ 48 49 50 ] However, similar to CEA, cyst fluid glucose level was unable to diagnose malignant PCNs. Therefore, cyst fluid glucose level is a promising biomarker in diagnosing mucinous cysts.…”