Sa1413 CYST FLUID GLUCOSE OBTAINED BY EUS-FNA IS ACCURATE FOR THE DIAGNOSIS OF MUCINOUS PANCREATIC CYSTS. EXPERIENCE FROM TWO TERCIARY CARE CENTERS

Abstract

Background: The differential diagnosis between mucinous(M) and non-mucinous (NM) pancreatic cystic lesions (PCLs) is often difficult and both false positive and negative results can lead to clinically relevant overtreatment and undertreatment. Dosage of intracystic Carcinoembryonic antigen (CEA) with a cut-off>192 ng/ml suggests the diagnosis of M-PCL, but its sensitivity is limited. Recently, it has been reported that low levels of intracystic glucose diagnose M-PCLs with high accuracy, but data are limited and heterogeneous. Objective: We aimed to perform a metaanalysis to gather data on sensitivity, specificity and accuracy of intracystic glucose as compared with CEA for the diagnosis of M-PCLs. Methods: A computerized bibliographic search was performed on Pubmed. Pooled effects were calculated using a random-effects model and expressed in terms of pooled sensitivity and specificity and OR (95% CI) for accuracy for the diagnosis of M-PCLs. Heterogeneity was evaluated by I 2 and publication bias by Begg-Mazumdar test and funnel plot visual inspection. Results: Overall, 4 cohort studies were included (3 conducted in the US, 1 in Portugal), for a total of 319 patients (207 M, 112 NM). The cut-off employed for glucose were 50 in 3 studies and 66 mg/dl in one, while all studies employed the CEA cut-off of 192 ng/ml. The employed gold-standard for diagnosis in the 4 studies was a composite of surgical pathology and cytology. Dosage of glucose showed a higher pooled sensitivity and lower heterogeneity (92%; I 2 Z 0%) compared to CEA (69.4%; I 2 Z64%), while specificity was higher for CEA (75.6% glucose vs 92% CEA) with lower heterogeneity (I 2 Z89% glucose vs 69% CEA). Dosage of glucose was very close to be significantly superior in terms of pooled accuracy (OR 1.96; 95% CI 0.97-3.94; pZ0.057; I 2 Z53%). There was no publication bias at Begg-Mazumdar test and funnel plot. Conclusion: Our meta-analysis suggests that intracystic dosage of glucose is more sensitive, but CEA more specific for the diagnosis of mucinous PCLs, with an overall better accuracy of glucose. Given the heterogeneity of the results and the relative low number of investigated patients considering the high prevalence of PCLs, more studies are needed to define if combined use of both markers with different cut-offs is needed to increase accuracy significantly.

Intracystic Glucose Levels in Differentiating Mucinous From Nonmucinous Pancreatic Cysts

“…1). All 375 studies were screened, and 25 full-length articles and/or abstracts were assessed, of which 15 studies9–15,22–29 were appropriate. However, after removing studies with overlapping cohorts,29 nonglucose-based analysis of the cyst fluid,28 studies reporting glucose with CEA as the sole reference standard,22,23,25–27 and accuracy rates of nonmucinous cysts without reporting that of mucinous,24 7 studies9–15 were included in the final analysis.…”

“…Mean age ranged from 60 to 66.9 years. Five studies used EUS-FNA guided fluid aspiration for analysis 10–13,15. One study used surgical aspiration alone9 and one study utilized a combination of both 14.…”

“…Three studies exclusively used glucometers in the analysis of cyst fluid glucose 9,10,14. Three studies sent their samples to laboratory for analysis12,13,15 and 1 study11 used a combination of glucometer and laboratory. The aspirated sample was sent to the laboratory within 3 hours in the study by Ribaldone et al,12 and within 30 minutes by Simons-Linares et al15…”

“…There is emerging data on the utility of analyzing glucose levels in pancreatic cyst fluid 9–15. A low intracystic glucose level has been reported to help in differentiating mucinous from nonmucinous pancreatic cysts 9–15.…”

Abordaje de lesiones quísticas de páncreas

“…La presencia de mutaciones en genes TP53/ SMAD4/mTOR identifican aquellos IPMN con neoplasia avanzada con una sensibilidad de 96% y especificidad de 100%. Otras mutaciones ayudan a identificar tumores neuroendocrinos con degeneración quística (MEN1/CNA) y cistadenoma seroso (VHL) 5,6 .…”