Abstract
A significant proportion of patients with intraductal papillary mucinous neoplasms (IPMNs) undergo surgical resection in order to prevent or treat pancreatic cancer at the risk of significant perioperative morbidity. Efforts have been made to stratify the potential risk of malignancy based on the clinical and radiographic features of IPMN to delineate which cysts warrant resection versus observation. An analysis of the cyst fluid obtained by preoperative endoscopic examination appears to be correlative of cyst type and risk, whereas serum markers and radiographic findings have not yet reached a level of sensitivity or specificity that proves they are clinically meaningful. In this review, we investigate the current cyst fluid analysis studies and present those that have shown promise in effectively stratifying high-risk versus low-risk lesions. While new cyst fluid markers continue to be identified, additional efforts in testing panels and marker composites in conjunction with clinical algorithms have also shown promise in distinguishing dysplasia and the risk of malignancy. These should be tested prospectively in order to determine their role in guiding the surveillance of low-risk lesions and to evaluate the new markers detected by proteomics and genetic sequencing.
Highlights
The incidence of intraductal papillary mucinous neoplasms (IPMNs) has increased significantly with the development and increasing use of cross-sectional non-invasive imaging, such as computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance cholangiopancreatography (MRCP)
Using enzyme-linked immunosorbent assays (ELISA), they quantified the concentration of Prostaglandin E2 (PGE2) and found higher levels of PGE2 in IPMNs compared to mucinous cystic neoplasms (MCN) (p < 0.05) and demonstrated that PGE2 concentration correlated stepwise with the degree of dysplasia within an IPMN
Of the 15 miRNAs investigated, miR-216 was the most strongly associated with dysplasia, with a higher expression of miR-216 in high-grade dysplasia (HGD)-IPMN and IPMNs with adenocarcinoma compared to low-grade dysplasia (LGD) IPMN (p = 0.011 and p = 0.020)
Summary
The incidence of intraductal papillary mucinous neoplasms (IPMNs) has increased significantly with the development and increasing use of cross-sectional non-invasive imaging, such as computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance cholangiopancreatography (MRCP). The American Gastroenterological Association (AGA) guidelines for pancreatic cysts define “high-risk” lesion characteristics as a size ≥3 cm, a dilated MPD, and mural nodules [16]. EUS with a fine needle aspiration (FNA) of cyst fluid is recommended for further analysis, which informs the decision to observe or resect. These guidelines have demonstrated improved sensitivity (50%) and accuracy (73.7%) compared to the Fukuoka guidelines but are less specific (89.1%) for the management of pancreatic cysts [16]. We present an updated review on the most promising cyst fluid markers in order to summarize current strategies for risk stratification and to identify future directions for further investigation
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
