Abstract
Pancreatic cystic lesions are increasingly detected in cross-sectional imaging. Intraductal papillary mucinous neoplasm (IPMN) is a mucin-producing subtype of the pancreatic cyst lesions arising from the pancreatic duct system. IPMN is a potential precursor of pancreatic cancer. The transformation of IPMN in pancreatic cancer is progressive and requires the occurrence of low-grade dysplasia, high-grade dysplasia, and ultimately invasive cancer. Jaundice, enhancing mural nodule >5 mm, main pancreatic duct diameter >10 mm, and positive cytology for high-grade dysplasia are considered high-risk stigmata of malignancy. While increased levels of carbohydrate antigen 19-9 (CA 19-9) (>37 U/mL), main pancreatic duct diameter 5–9.9 mm, cyst diameter >40 mm, enhancing mural nodules <5 mm, IPMN-induced acute pancreatitis, new onset of diabetes, cyst grow-rate >5 mm/year are considered worrisome features of malignancy. However, cross-sectional imaging is often inadequate in the prediction of high-grade dysplasia and invasive cancer. Several studies evaluated the role of humoral and intra-cystic biomarkers in the prediction of malignancy in IPMN. Carcinoembryonic antigen (CEA), CA 19-9, intra-cystic CEA, intra-cystic glucose, and cystic fluid cytology are widely used in clinical practice to distinguish between mucinous and non-mucinous cysts and to predict the presence of invasive cancer. Other biomarkers such as cystic fluid DNA sequencing, microRNA (mi-RNA), circulating microvesicles, and liquid biopsy are the new options for the mini-invasive diagnosis of degenerated IPMN. The aim of this study is to review the literature to assess the role of humoral and intracystic biomarkers in the prediction of advanced IPMN with high-grade dysplasia or invasive carcinoma.
Highlights
Intraductal papillary mucinous neoplasm (IPMN) is a mucin-producing subtype of the pancreatic cyst lesions arising from the pancreatic duct system [1]
The Neutrophil to lym- have phocyte ratio (NLR) remains an easy to perform cost-effective diagnostic marker for predicting IPMN associated with invasive carcinoma, especially when combined with other factors
Several cytological findings can help to distinguish the different pancreatic cists: for example, the presence of macrophages, histiocytes, and neutrophils is suggestive of pseudocyst; the presence of mucin is suggestive of mucinous neoplasm; the presence of glycogen-rich cuboidal cells indicate a serous cystic neoplasm [59]
Summary
Intraductal papillary mucinous neoplasm (IPMN) is a mucin-producing subtype of the pancreatic cyst lesions arising from the pancreatic duct system [1]. IPMN and mucinous cystic neoplasm (MCN) are considered precursors of pancreatic cancer and it is estimated that 8% of pancreatic malignancies arise from these lesions [4]. From cross-sectional imaging, EUS allows features of malignancy with a sensitivity of 56–78%, and a specificity of 45–67%the for the performance of Fine-Needle-Aspiration (FNA) for a biochemical Cross-sectional sectional imaging, EUS allows the performance of Fine-Needle-Aspiration (FNA) for a imaging and EUS are considered the gold standard to detect, worrisome features of maligbiochemical (CEA,several amylase, glucose, and mucin dosage) and tools cytological of the nancy in IPMN, biomarkers have been described as useful in daily study practice. Sequencing, microRNA (mi-RNA), circulating microvesicles, and liquid biopsy have been
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