Abstract
BackgroundAccurate tests to diagnose adenocarcinoma and high-grade dysplasia among mucinous pancreatic cysts are clinically needed. This study evaluated the diagnostic utility of amphiregulin (AREG) as a pancreatic cyst fluid biomarker to differentiate non-mucinous, benign mucinous, and malignant mucinous cysts.MethodsA single-center retrospective study to evaluate AREG levels in pancreatic cyst fluid by ELISA from 33 patients with a histological gold standard was performed.ResultsAmong the cyst fluid samples, the median (IQR) AREG levels for non-mucinous (n = 6), benign mucinous (n = 15), and cancerous cysts (n = 15) were 85 pg/ml (47-168), 63 pg/ml (30-847), and 986 pg/ml (417-3160), respectively. A significant difference between benign mucinous and malignant mucinous cysts was observed (p = 0.025). AREG levels greater than 300 pg/ml possessed a diagnostic accuracy for cancer or high-grade dysplasia of 78% (sensitivity 83%, specificity 73%).ConclusionCyst fluid AREG levels are significantly higher in cancerous and high-grade dysplastic cysts compared to benign mucinous cysts. Thus AREG exhibits potential clinical utility in the evaluation of pancreatic cysts.
Highlights
Accurate tests to diagnose adenocarcinoma and high-grade dysplasia among mucinous pancreatic cysts are clinically needed
We examined the diagnostic utility of AREG in pancreatic cyst fluid and observed no difference in cyst AREG concentrations between non-mucinous and benign mucinous cysts
The present study represents the translation of recent discoveries in the basic biology of adenocarcinomas to clinical utility in the evaluation of pancreatic cysts
Summary
Accurate tests to diagnose adenocarcinoma and high-grade dysplasia among mucinous pancreatic cysts are clinically needed. Various diagnostic tests, including endoscopic ultrasound (EUS), are employed to facilitate diagnosis and management of pancreatic cysts [5,6]. EUS guided aspiration of cyst fluid provides an opportunity to evaluate for tumor markers such as carcinoembryonic antigen (CEA) that can differentiate mucinous from non-mucinous cysts with reasonable accuracy. Because progression to cancer may be slow and variable among pre-malignant mucinous cysts, a biomarker that identifies cysts with cancer or high-grade dysplasia may have clinical value by identifying which patients may benefit from immediate consideration for surgery [9,10,11,12]
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