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.
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References
Stark A, Donahue TR, Reber HA, Hines OJ. Pancreatic cyst disease: a review. Jama. 2016;315:1882–1893.
Kamisawa T, Young J, Tanaka M, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 2017;17:738–753.
Springer S, Wang Y, Dal Molin M, et al. A combination of molecular markers and clinical features improve the classification of pancreatic cysts. Gastroenterology. 2015;149:1501–1510.
Singhi AD, Koay EJ, Chari ST, Maitra A. Early detection of pancreatic cancer: opportunities. Gastroenterology. 2019;156:2024–2040.
Tanaka M. Intraductal papillary mucinous neoplasm of the pancreas as the main focus for early detection of pancreatic adenocarcinoma. Pancreas. 2018;47:544–550.
Khalid A, Zahid M, Finkelstein SD, Leblanc JK. Pancreatic cyst fluid DNA analysis in evaluating pancreatic cysts: a report of the PANDA study. Gastrointest Endosc. 2009;69:1095–1102.
Gaddam S, Ge PS, Keach JW, et al. Suboptimal accuracy of carcinoembryonic antigen in differentiation of mucinous and nonmucinous pancreatic cysts: results of a large multicenter study. Gastrointest Endosc. 2015;82:1060–1069.
Levy A, Popovici T, Bories PN. Tumor markers in pancreatic cystic fluids for diagnosis of malignant cysts. Int J Biol Markers. 2017;32:e291–e296.
Thiruvengadam N, Park WG. Systematic review of pancreatic cyst fluid biomarkers: the path forward. Clin Transl Gastroenterol. 2015;6:e88–e89.
Singhi AD, Nikiforova MN, McGrath K. DNA testing of pancreatic cyst fluid: is it ready for prime time? Lancet Gastroenterol Hepatol. 2017;2:63–72.
Rosenbaum MW, Jones M, Dudley JC, et al. Next-generation sequencing adds value to the preoperative diagnosis of pancreatic cysts. Cancer Cytopathol. 2017;125:41–47.
Jones M, Zheng Z, Wang J, et al. Impact of next-generation sequencing on the clinical diagnosis of pancreatic cysts. Gastrointest Endosc. 2016;83:140–148.
Park WG, Wu M, Bowen R, et al. Metabolomic-derived novel cyst fluid biomarkers for pancreatic cysts: glucose and kynurenine. Gastrointest Endosc. 2013;78:295–302.
Zikos T, Pham K, Bowen R, et al. Cyst fluid glucose is rapidly feasible and accurate in diagnosing mucinous pancreatic cysts. Am J Gastroenterol. 2015;110:909–914.
Carr RA, Yip-Schneider MT, Simpson RE, et al. Pancreatic cyst fluid glucose: rapid, inexpensive, and accurate diagnosis of mucinous pancreatic cysts. Surgery. 2017;163:600–605.
OneTouch Verio Blood Glucose Monitoring System Owner’s Booklet. Life Scan Europe. Switzerland; 2014: 10–78.
Chari ST, Clain JE, Farnell MB, et al. The string sign for diagnosis of mucinous pancreatic cysts. Endoscopy. 2015;47:626–631.
Stevens VL, Hoover E, Wang Y, Zanetti CA. Pre-analytical factors that affect metabolite stability in human urine, plasma and serum: a review. Metabolites. 2019;9:156.
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Faias, S., Pereira, L., Roque, R. et al. Excellent Accuracy of Glucose Level in Cystic Fluid for Diagnosis of Pancreatic Mucinous Cysts. Dig Dis Sci 65, 2071–2078 (2020). https://doi.org/10.1007/s10620-019-05936-5
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DOI: https://doi.org/10.1007/s10620-019-05936-5