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Excellent Accuracy of Glucose Level in Cystic Fluid for Diagnosis of Pancreatic Mucinous Cysts

  • Sandra FaiasEmail author
  • Luisa Pereira
  • Ruben Roque
  • Paula Chaves
  • Joana Torres
  • Marília Cravo
  • A. Dias Pereira
Original Article
  • 27 Downloads

Abstract

Background

CEA in pancreatic cystic fluid (PCF) is standard for mucinous cysts diagnosis. Glucose is an alternative, but its accuracy remains poorly described.

Aims

To evaluate PCF glucose using a glucometer and compare its accuracy with CEA for mucinous cysts diagnosis.

Materials and Methods

In frozen PCF obtained by EUS-FNA, glucose was evaluated using a glucometer. CEA and cytology were available as standard of care. The accuracy of glucose and CEA was calculated using receiver operator (ROC) curves. Definitive diagnoses were surgical or clinicopathological.

Results

We evaluated 82 patients with a mean age of 61.3 ± 14.8 years (25–91), predominantly (59%) females. Diagnoses included 17 serous cystadenomas, five pseudocysts, 20 intraductal papillary mucinous neoplasms, three mucinous cystic neoplasms, five adenocarcinomas, four neuroendocrine tumors, two other types, 26 non-defined. The median glucose levels (interquartile range) were 19 mg/dL (19–19) in mucinous and 105 mg/dL (96–127) in non-mucinous cysts (p < 0.0001). The median CEA level was 741 ng/mL (165–28,567) in mucinous and 9 ng/mL (5–19) in non-mucinous cysts (p < 0.0001). For mucinous cyst diagnosis, a CEA > 192 ng/mL had a sensitivity of 72% (95% CI 51–88) and a specificity of 96% (95% CI 82–100), and ROC analysis showed an area under the curve (AUC) of 0.842 (95% CI 0.726–0.959), while glucose < 50 mg/dL had a sensitivity of 89% (95% CI 72–98), a specificity of 86% (95% CI 67–96), and an AUC of 0.86 (95% CI 0.748–0.973). Pseudocysts presented low glucose, identically to mucinous cysts, with CEA allowing differential diagnosis.

Conclusion

Glucose measured by a glucometer is accurate for mucinous cyst diagnosis, with significantly higher levels in non-mucinous cysts, except pseudocysts.

Keywords

Glucose CEA Pancreatic cyst EUS-FNA IPMN MCN 

Notes

Funding

The authors have no funding support to disclosure concerning this study.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

10620_2019_5936_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 16 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Gastroenterology DepartmentInstituto Português de Oncologia de Lisboa Francisco Gentil EPELisbonPortugal
  2. 2.Faculty of Health SciencesUniversity of Beira InteriorCovilhãPortugal
  3. 3.Center of Mathematics and Applications (CMA-UBI)University of Beira InteriorCovilhãPortugal
  4. 4.Pathology DepartmentInstituto Português de Oncologia de Lisboa Francisco Gentil EPELisbonPortugal
  5. 5.Gastroenterology DepartmentHospital Beatriz ÂngeloLouresPortugal
  6. 6.Faculty of MedicineUniversity of LisbonLisbonPortugal

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