Role of endoscopic ultrasound and cyst fluid tumor markers in diagnosis of pancreatic cystic lesions

Abstract

BACKGROUND Pancreatic cystic lesions (PCLs) are common in clinical practice. The accurate classification and diagnosis of these lesions are crucial to avoid unnecessary treatment of benign lesions and missed opportunities for early treatment of potentially malignant lesions. AIM To evaluate the role of cyst fluid analysis of different tumor markers such as cancer antigens [ e.g. , cancer antigen (CA)19-9, CA72-4], carcinoembryonic antigen (CEA), serine protease inhibitor Kazal-type 1 (SPINK1), interleukin 1 beta (IL1-β), vascular endothelial growth factor A (VEGF-A), and prostaglandin E2 (PGE2)], amylase, and mucin stain in diagnosing pancreatic cysts and differentiating malignant from benign lesions. METHODS This study included 76 patients diagnosed with PCLs using different imaging modalities. All patients underwent endoscopic ultrasound (EUS) and EUS-fine needle aspiration (EUS-FNA) for characterization and sampling of different PCLs. RESULTS The mean age of studied patients was 47.4 ± 11.4 years, with a slight female predominance (59.2%). Mucin stain showed high statistical significance in predicting malignancy with a sensitivity of 87.1% and specificity of 95.56%. It also showed a positive predictive value and negative predictive value of 93.1% and 91.49%, respectively ( P < 0.001). We found that positive mucin stain, cyst fluid glucose, SPINK1, amylase, and CEA levels had high statistical significance ( P < 0.0001). In contrast, IL-1β, CA 72-4, VEGF-A, VEGFR2, and PGE2 did not show any statistical significance. Univariate regression analysis for prediction of malignancy in PCLs showed a statistically significant positive correlation with mural nodules, lymph nodes, cyst diameter, mucin stain, and cyst fluid CEA. Meanwhile, logistic multivariable regression analysis proved that mural nodules, mucin stain, and SPINK1 were independent predictors of malignancy in cystic pancreatic lesions. CONCLUSION EUS examination of cyst morphology with cytopathological analysis and cyst fluid analysis could improve the differentiation between malignant and benign pancreatic cysts. Also, CEA, glucose, and SPINK1 could be used as promising markers to predict malignant pancreatic cysts.

In-Depth Analysis of the N-Glycome of Colorectal Cancer Cell Lines

“…Currently, carcinoembryonic antigen (CEA) and carbohydrate antigen (CA)19-9 are used as tumor markers in clinical practice for the diagnosis, prognosis, and monitoring of CRC patients [46][47][48][49][50]. Nonetheless, as these markers exhibit low specificities and suboptimal sensitivities, especially in the early stages of the disease [51][52][53][54], there is an urgent need for novel biomarkers and therapeutic targets. Cancer progression frequently correlates with N-glycome alterations [55], making the discovery of tumor-associated carbohydrate antigens (TACAs) a promising area for identifying the new molecular signatures of tumors for improved diagnostics, stratification, and targeted treatment [21,56].…”

Diagnosis and management of pancreatic cystic lesions for the non-gastroenterologist

“…Lately, remarkable progress has been made in the identifi cation and validation of molecular cyst fl uid biomarkers such as KRAS, GNAS, SPINK1, interleukin-1-beta, cancer antigen 72-4, vascular endothelial growth factor-A, vascular endothelial growth factor receptor 2, prostaglandin E2, and methylated DNA biomarkers. [30][31][32][33][34][35] These biomarkers play a pivotal role in aiding the diagnostic process, contributing to improved accuracy in assessing PCLs.…”

Using Endoscopy in the Diagnosis of Pancreato-Biliary Cancers

“…Both endoscopic ultrasound (EUS)- and endoscopic retrograde cholangiopancreatography (ERCP)-based techniques can offer substantial information that can be used for determining the diagnosis of both solid lesions and PCLs, as well as undetermined biliary and/or pancreatic strictures. Additionally, a multidisciplinary approach is required to offer appropriate management and avoid misdiagnosis and unnecessary surgical resections that are potentially related to morbidity and mortality [ 10 , 11 , 12 ].…”