Molecular assessment of endoscopically collected pancreatic juice and duodenal fluid from patients with pancreatic diseases

Abstract

One concern associated with pancreatic diseases is the poor prognosis of pancreatic cancer. Even with advances in diagnostic modalities, risk stratification of premalignant lesions and differentiation of pancreatic cysts are challenging. Pancreatic lesions of concern include intraductal papillary mucinous neoplasms, mucinous cystic neoplasms, serous cystadenomas, pseudocysts, and retention cysts, as well as cystic degeneration of solid tumors such as solid pseudopapillary neoplasms and pancreatic neuroendocrine neoplasms. Pancreatic juice obtained during endoscopic retrograde cholangiopancreatography has previously been used for the detection of KRAS mutation. Recently, duodenal fluid, which can be obtained during the relatively minimally invasive procedures of endoscopic ultrasound (EUS) and esophagogastroduodenoscopy, and cyst fluid collected by EUS‐guided fine‐needle aspiration (FNA) were used for molecular biological analysis. Furthermore, advanced analytic methods with high sensitivity were used for the detection of single and multiple markers. Early detection of malignant pancreatic tumors and risk stratification of premalignant tumors can be performed using duodenal fluid samples with a single marker with high sensitivity. Technological advances in simultaneous detection of multiple markers allow for the differentiation of cystic pancreatic tumors. One thing to note is that the clinical guidelines do not recommend pancreatic cyst fluid and pancreatic juice (PJ) sampling by EUS‐FNA and endoscopic retrograde cholangiopancreatography, respectively, in actual clinical practice, but state that they be performed at experienced facilities, and duodenal fluid sampling is not mentioned in the guidelines. With improved specimen handling and the combination of markers, molecular markers in PJ samples may be used in clinical practice in the near future.

Unraveling the enigma: A comprehensive review of solid pseudopapillary tumor of the pancreas

“…EUS-guided fine needle aspiration (EUS-FNA) is increasingly utilized in pancreatic tumor diagnosis, with both sensitivity and specificity exceeding 80%[ 44 ]. In addition to biopsy, EUS-FNA allows for the minimally-invasive collection of fluid samples, including pancreatic juice and cyst fluid[ 42 , 45 ]. Table 1 summarizes the results of cyst fluid analysis for various pancreatic cystic diseases[ 45 - 47 ].…”

“…In addition to biopsy, EUS-FNA allows for the minimally-invasive collection of fluid samples, including pancreatic juice and cyst fluid[ 42 , 45 ]. Table 1 summarizes the results of cyst fluid analysis for various pancreatic cystic diseases[ 45 - 47 ]. Considering the predominant solid component in SPTP and the limited diagnostic accuracy of cyst fluid analysis, EUS-guided fine needle biopsy (EUS-FNB) can be a more valuable diagnostic tool.…”

Making incurable pancreatic cancer curable

“…Therefore, early detection and diagnosis are crucial to ensure that patients have the opportunity to receive curative treatment from the outset. Currently, researchers have identified several potential early diagnostic methods for PDAC, including genetic markers associated with PDAC risk, microbial characteristics in the feces, circulating tumor DNA (ctDNA) in the bloodstream, and biomarkers in pancreatic fluid or mucosal samples [5][6][7][8][9].…”

Modern aspects of the management of pancreatic intraductal papillary mucinous neoplasms: a narrative review

“…The serum biomarker fucosylated α1-acid glycoprotein (fAGP) indicates malignant potential and, in combination with 18FDG–PET/CT, is a valuable diagnostic tool [ 77 ]. Pancreatic juice and duodenal fluid obtained by endoscopic methods have been used recently for molecular biological analysis [ 78 , 79 ]. A recent meta-analysis including 32 studies and 939 cases of DNA analysis, found that mutations in KRAS, TP53, CDKN2A, GNAS and SMAD4 have a high specificity (approaching 100%) for high-grade dysplasia or pancreatic carcinoma [ 80 ].…”