Multiinstitutional validation study of cyst fluid protein biomarkers in patients with cystic lesions of the pancreas Journal Article
| Authors: | McIntyre, C. A.; Rodrigues, C.; Santharaman, A. V.; Goldman, D. A.; Javed, A. A.; Ciprani, D.; Pang, N.; Lokshin, A.; Gonen, M.; Al Efishat, M. A.; He, J.; Burkhart, R.; Burns, W. 3rd; Weiss, M.; D'Angelica, M. I.; Kingham, T. P.; Balachandran, V. P.; Drebin, J. A.; Jarnagin, W. R.; Lillemoe, K. D.; Brugge, W.; Casey, B.; Lennon, A. M.; Schattner, M.; Wolfgang, C. L.; del Castillo, C. F.; Allen, P. J. |
| Article Title: | Multiinstitutional validation study of cyst fluid protein biomarkers in patients with cystic lesions of the pancreas |
| Abstract: | Objective: Prospective evaluation of 2 clinical-molecular models in patients with unknown pathology who underwent endoscopic ultrasound with fine-needle aspiration (EUS-FNA) for a cystic lesion of the pancreas. Summary of Background Data: Preoperative prediction of histologic subtype (mucinous vs nonmucinous) and grade of dysplasia in patients with pancreatic cystic neoplasms is challenging. Our group has previously published 2 clinical-molecular nomograms for intraductal papillary mucinous neoplasms (IPMN) that incorporated both clinical/radiographic features and cyst fluid protein markers (sFASL, CA72-4, MMP9, IL-4). Methods: This multiinstitutional study enrolled patients who underwent EUS-FNA for a cystic lesion of the pancreas. Treatment recommendations regarding resection were based on standard clinical, radiographic, and endoscopic features. Predicted probabilities of high-risk IPMN (high-grade dysplasia/invasive cancer) were calculated using the previously developed clinical-molecular nomograms. Results: Cyst fluid was obtained from 100 patients who underwent diagnostic EUS-FNA. Within this group there were 35 patients who underwent resection, and 65 were monitored radiographically. Within the group that underwent resection, 26 had low-risk IPMN or benign non-IPMN lesions, and 9 had high-risk IPMN. Within the surveillance group, no patient progressed to resection or developed cancer after a median follow-up of 12months (range: 0.5-38). Using the clinical/radiographic nomogram alone, 2 out of 9 patients with high-risk IPMN had a predicted probability >0.5. In the clinical-molecular models, 6 of 9 patients in model 1, and 6 of 9 in model 2, had scores >0.5. Conclusions: This prospective study of patients with unknown cyst pathology further demonstrates the importance of cyst fluid protein analysis in the preoperative identification of patients with high-risk IPMN. Longer follow-up is necessary to determine if this model will be useful in clinical practice. © 2022 Lippincott Williams and Wilkins. All rights reserved. |
| Keywords: | adult; controlled study; human tissue; aged; major clinical study; cancer risk; follow up; preoperative evaluation; prospective study; clinical assessment; carcinoembryonic antigen; fas ligand; gelatinase b; interleukin 4; intraductal papillary mucinous tumor; pancreas cyst; cyst fluid; cohort analysis; validation study; prediction; risk assessment; probability; pancreas biopsy; nomogram; molecular model; dysplasia; ca 72-4 antigen; disease surveillance; pancreas surgery; fine needle aspiration biopsy; pancreatography; endoscopic ultrasonography; human; male; female; article |
| Journal Title: | Annals of Surgery |
| Volume: | 276 |
| Issue: | 2 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2022-08-01 |
| Start Page: | e129 |
| End Page: | e132 |
| Language: | English |
| DOI: | 10.1097/sla.0000000000005314 |
| PUBMED: | 34793354 |
| PROVIDER: | scopus |
| PMCID: | PMC9114163 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 August 2022 -- Source: Scopus |
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