Pancreatic Cyst Disease

Stark, Alexander P.; Donahue, Timothy R.; Reber, Howard A.; Hines, Oscar J.

doi:10.1001/jama.2016.4690

Cited by 203 publications

(164 citation statements)

References 100 publications

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“…7,8 Most have not caused any discomfort. 5,6 The high prevalence of PCLs, their usually asymptomatic nature, and the perils of pancreatic surgery naturally exclude general prophylactic intervention, rendering accurate differential diagnosis critical. 9,10 Radiology is seldom sufficient for the assessment of PCLs.…”

Section: 6mentioning

confidence: 99%

“…9,10 Radiology is seldom sufficient for the assessment of PCLs. 5,6,11 The preferred method is endoscopic ultrasound (EUS), with aspiration of cyst fluid for cytology and quantification of carcinoembryonic antigen (CEA). 5,6,12,13 However, even these analyses cannot robustly distinguish between benign, premalignant, and malignant PCLs.…”

Section: 6mentioning

confidence: 99%

“…5,6,11 The preferred method is endoscopic ultrasound (EUS), with aspiration of cyst fluid for cytology and quantification of carcinoembryonic antigen (CEA). 5,6,12,13 However, even these analyses cannot robustly distinguish between benign, premalignant, and malignant PCLs. 5,6 The utility of cytology is hampered by scant cellular yield and the focal nature of the dysplasia.…”

Section: 6mentioning

confidence: 99%

“…1,2 Together, these neoplasms comprise 10% to 50% of pancreatic cystic lesions (PCLs). 5,6 However, PCLs also encompass intrinsically benign tumors, that is, serous cystic neoplasms and inflammatory pseudocysts.…”

Section: Introductionmentioning

confidence: 99%

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Highly Accurate Identification of Cystic Precursor Lesions of Pancreatic Cancer Through Targeted Mass Spectrometry: A Phase IIc Diagnostic Study

Jabbar

Arike

Verbeke

et al. 2018

JCO

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Pancreatic cystic lesions are common incidental findings on imaging, but up to half may be forerunners of pancreatic cancer. Therefore, accurate differential diagnosis is crucial for correct patient management. Unfortunately, currently available diagnostic methods cannot robustly identify premalignant and malignant pancreatic cystic lesions. MethodsCyst fluid samples obtained by routine endoscopic ultrasound-guided aspiration were used for the analyses. In a cohort of 24 patients, eight biomarker candidates for malignant potential and highgrade dysplasia/cancer were identified by an explorative proteomic approach. Subsequently, a quantitative analysis, using 30 heavy-labeled peptides from the biomarkers and parallel reaction monitoring mass spectrometry, was devised, tested in a training cohort of 80, and prospectively evaluated in a validation cohort of 68 patients. End points were surgical pathology diagnosis/clinical follow-up. Diagnostic assessments were blinded to mass spectrometry results. ResultsThe optimal set of markers for detecting malignant potential was a panel of peptides from mucin-5AC and mucin-2, which could discriminate premalignant/malignant lesions from benign with an accuracy of 97% (95% CI, 89% to 99%) in the validation cohort. This result compared favorably with the accuracy of standard analyses: cyst fluid carcinoembryonic antigen (61%; 95% CI, 46% to 74%; P , .001) and cytology (84%; 95% CI, 71% to 92%; P = .02). A combination of proteins mucin-5AC and prostate stem-cell antigen could identify high-grade dysplasia/cancer with an accuracy of 96% (95% CI, 90% to 99%), and detected 95% of malignant/severely dysplastic lesions, compared with 35% and 50% for carcinoembryonic antigen and cytology (P , .001 and P = .003, respectively). ConclusionTargeted mass spectrometry analysis of just three cyst fluid biomarkers provides highly accurate identification and assessment of cystic precursors to pancreatic adenocarcinoma. Additional studies should determine whether the method can facilitate timely cancer diagnosis, successful intervention, and prevention.

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Section: 6mentioning

confidence: 99%

Section: 6mentioning

confidence: 99%

Section: 6mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Highly Accurate Identification of Cystic Precursor Lesions of Pancreatic Cancer Through Targeted Mass Spectrometry: A Phase IIc Diagnostic Study

Jabbar

Arike

Verbeke

et al. 2018

JCO

View full text Add to dashboard Cite

show abstract

“…Surgical resection and surveillance are the standard management approaches at present. Surgical resection has substantial perioperative morbidity and mortality; surveillance increases economic and psychological burden of the patients, and it may also lead to delayed treatment because the current differential diagnosis is still limited (2,4). Meantime, a substantial portion of PCNs remains indeterminate even after comprehensive evaluation (5).…”

Section: Introductionmentioning

confidence: 99%