Intracystic Glucose Levels in Differentiating Mucinous From Nonmucinous Pancreatic Cysts

Abstract

Background: Mucinous pancreatic cysts are well reported to transform into pancreatic adenocarcinoma, whereas nonmucinous cysts are mostly benign with low risk for malignant transformation. Nonsurgical methods of differentiating mucinous and nonmucinous pancreatic cysts are challenging and entail a multi investigational approach. Low intracystic glucose levels have been evaluated in multiple studies for its accuracy in differentiating mucinous from nonmucinous cysts of the pancreas. Methods: Multiple databases were searched and studies that reported on the utility of intracystic glucose levels in diagnosing mucinous pancreatic cysts were analyzed. Meta-analysis was conducted using the random-effects model, heterogeneity was assessed by I 2%, and pooled diagnostic test accuracy values were calculated. Results: Seven studies were included in the analysis from an initial total of 375 citations. The pooled sensitivity of low glucose in differentiating mucinous pancreatic cyst was 90.5% [95% confidence interval (CI): 88.1-92.5; I 2=0%] and the pooled specificity was 88% (95% CI: 80.8-92.7; I 2=79%). The sensitivity at a glucose cut-off of 50 was 90.1% (95% CI: 87.2-92.5; I 2=0%) and the specificity was 85.3% (95% CI: 76.8-91.1; I 2=76%). The sensitivity of glucose levels in pancreatic cyst fluid taken by endoscopic ultrasound guided fine-needle aspiration was 90.8% (95% CI: 87.9-93.1; I 2=0%) and the specificity was 90.5% (95% CI: 81.7-95.3; I 2=83%). The sensitivity of point-of-care glucometers was 89.5% (95% CI: 87.9-93.1; I 2=0%) and specificity was 83.9% (95% CI: 68.5-92.6; I 2=43%). Conclusions: Low glucose level at a cut-off of 50 mg/dL on fluid samples collected by endoscopic ultrasound guided fine-needle aspiration and analyzed by point-of-care glucometer achieves excellent diagnostic accuracy in differentiating mucinous pancreatic cysts.

Pancreatic cyst fluid glucose: a rapid on-site diagnostic test for mucinous cysts

“…The current study assesses the accuracy of PCF glucose levels for mucinous cyst diagnosis using laboratory as well as on-site glucometry measurement. Consistent with previous studies, including the original study by Park et al 8 and the recent meta-analysis by Mohan et al 15 that demonstrated a pooled sensitivity of 90.5% and a pooled specificity of 88%, our results demonstrated similar findings as low intracystic glucose (using the cutoff of 60 mg/dL) had a sensitivity of 80-87.7% and specificity of 84.6-90% in diagnosing mucinous cysts. Furthermore, although previous studies used glucose cutoff level between 50-73 mg/dL, our statistical analysis using the CART method demonstrated an improved diagnostic ability with higher glucose cutoff level of 87 mg/dL, and according to a recent meta-analysis, the mean intra-cystic glucose for mucinous lesions was 15.92 ± 6.20 and for nonmucinous lesions is 94.03 ± 12.23.…”

“…The prevalence of mucinous cysts in our study cohort is relatively higher than previous studies with 76% mucinous cysts, while the average prevalence according to a recent meta-analysis is about 60%. 15 The lower prevalence of non-mucinous cysts in our study cohort is most likely the result of a low neoplastic potential of the non-mucinous cysts according to clinical, radiological, and sonographic features, which usually do not require further analysis by EUS-FNA. The following characteristic can on one hand suggest more realistic glucose range and cutoff level for mucinous cysts, and on the other hand might suggest misclassification of mucinous cysts.…”

A rare case of pancreatic macrocystic serous cystadenoma in an adolescent: a case report and literature review

“… 15 – 17 A meta-analysis published in 2022 suggested that low glucose levels in cystic fluid (cut-off point: 50 mg/dL) could be used to differentiate mucinous from non-mucinous cysts of the pancreas (sensitivity: 90.8%, specificity: 90.5%). 18 For SCA/MSC, a study from 2020 reported that α-inhibin-positive cuboidal cells from aspirated cystic fluid could be helpful for diagnosing SCA. 19 However, these conclusions need to be verified by more large-scale studies.…”

Recent advances in the diagnostic evaluation of pancreatic cystic lesions

“…A meta-analysis of 7 studies encompassing 566 patients reported that lower (cut-off < 50 mg/dL) intra-cystic glucose concentration had a pooled sensitivity of 90.1% (95%CI: 87.2-92.5) and pooled specificity of 85.3% (95%CI: 76.8-91.1) when differentiating mucinous from non-mucinous cysts[ 35 ]. In a subset analysis, point-of-care glucometer measurements for intra-cystic glucose (3 studies) also revealed comparable pooled sensitivity of 89.5% (95%CI: 85.5-92.5; I 2 = 0) and pooled specificity of 83.9% (95%CI: 68.5-92.6; I 2 = 43) for the differentiation of PCLs[ 35 ].…”

“…A meta-analysis of 7 studies encompassing 566 patients reported that lower (cut-off < 50 mg/dL) intra-cystic glucose concentration had a pooled sensitivity of 90.1% (95%CI: 87.2-92.5) and pooled specificity of 85.3% (95%CI: 76.8-91.1) when differentiating mucinous from non-mucinous cysts[ 35 ]. In a subset analysis, point-of-care glucometer measurements for intra-cystic glucose (3 studies) also revealed comparable pooled sensitivity of 89.5% (95%CI: 85.5-92.5; I 2 = 0) and pooled specificity of 83.9% (95%CI: 68.5-92.6; I 2 = 43) for the differentiation of PCLs[ 35 ]. A more recent (2021) meta-analysis that included 8 studies with 609 PCLs showed pooled sensitivities for glucose vs CEA of 91% (95%CI: 88-94) vs 56% (95%CI 46-66) (comparative P value < 0.001), pooled specificities were 86% (95%CI: 81-90) vs 96% (95%CI: 90-99), P > 0.05, respectively[ 36 ].…”