Abstract
Differentiation between mucinous and non-mucinous pancreatic cysts is exceedingly important and challenging, particularly as the former bears malignant transformation potential. Pancreatic cyst fluid (PCF)-based diagnostics, including analyses of biochemical markers, as well as cytology, has shown inadequate accuracy. Herein, a preliminary single-center study of 22 PCF samples, collected by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), assessed the rheological behavior of PCF and its correlation with lesion type. The dependence of PCF shear viscosity on shear rate was found to follow a power law and could be fitted using Ostwald–de Waele model. Three types of flow curves were identified, where two types correlated with non-mucinous cysts, differing by their power law exponent, and the third type corresponding to mucinous cysts. Viscosity measured at a high shear rate was shown to serve as an accurate and independent marker distinguishing between mucinous and non-mucinous cysts, with an optimal cutoff value of ηc = 1.3 cP The accuracy of this novel technique proved superior to string-sign, cytology, carcinoembryonic antigen, and amylase assessments. Moreover, the combined predictive value of ηc and patient age provided for sensitivity and specificity of 100% and 95.5%, respectively. This simple and rapid diagnostic tool can be immediately implemented after EUS-FNA sampling.
Highlights
Imaging plays a vital role in both detection and characterization of pancreatic cyst lesions
Cysts were classified as mucinous cyst (MC) or non-mucinous cyst (NMC), based on surgical and/or clinical findings
These findings indicate that η∞ is a potentially suitable marker for distinguishing between MC and NMC
Summary
Imaging plays a vital role in both detection and characterization of pancreatic cyst lesions. It was reported that a higher break length of the cyst fluid correlates with a lower likelihood of a benign cyst, while a 1 mm increase in break length corresponds to a 116% increase in the likelihood of a mucinous cyst[2]. This feature may be the result of loss of elasticity in the fluid, or disentanglement of the protein network as a result of the capillary pressure in the thread, which tends towards very high values[20]. The relative viscosity of fluid from benign cysts has been shown to be significantly lower than of fluids derived from mucinous and malignant cysts. It was shown that the combination of several markers, such as viscosity and age of patient, increased diagnostic sensitivity, specificity and accuracy, and bear prognostic value and factors to integrate in clinical decision-making guidelines
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