In contradistinction to other solid viscera, simple cysts in the pancreas are a rare entity 5. Pancreatic cysts i have a cyst in my pancreasnow what. Preoperative cyst fluid analysis is useful for the. Further studies can shed more light on cyst fluid string sign and its utility but it appears like a promising tool in the diagnostic arsenal for pancreatic cysts. The pancreatic cyst fluids pcf were collected after a signed informed consent from these patients, who were undergoing endoscopic ultrasound fine needle aspiration eusfna at the department of. Analysis of fluid obtained by the cyst via a fine needle is then used to differentiate between types of cysts and pseudocysts. Pancreaseq utilizes an amplificationbased targeted next generation sequencing of dna isolated from cyst fluid.
With increasing use of imaging tests such as computed tomography ct or magnetic resonance imaging mri, pancreatic cysts are now being detected with increasing frequency. Pancreatic pseudocysts are usually complications of pancreatitis, although in children they frequently occur following abdominal tra. Few initial studies have shown promise with this technique over fna and other types of cyst fluid analysis in predicting the biologic features of cysts 84. Decision tree analysis of pancreatic cyst fluid data for the detection of mucinous cysts 73. Cyst fluid biomarkers diagnosis and prediction of malignancy for. A pancreatic cyst is a fluid filled sac within the pancreas causes range from benign to malignant. Cytological analysis can reveal features that are specific for a certain class of cyst, but offers limited sensitivity in detecting malignantpremalignant cysts. Endoscopic ultrasoundguided fine needle aspiration and cyst. Sensitivity, however, was poor with only 1229 mucinous cysts being detected by staining.
Though cyst fluid glucose levels have been shown to be a reliable marker for differentiating mucinous and nonmucinous pancreatic cysts, a number of cysts have a more complex association with cea and amylase. Analysis of pancreatic cyst fluid johns hopkins university. Decision tree analysis of pancreatic cyst fluid data for. Using information from more than 800 patients with pancreatic cysts who had cyst fluid analysis and cyst removal surgery at the johns hopkins hospital and 15 other medical centers around the world, investigators say compcyst more often than standard current methods correctly identified which patients needed and likely had a chance to benefit from surgery, and which were unlikely to benefit. Molecular analysis of pancreatic cyst fluid holds promise as one such tool.
Many incidentally identified pancreatic cysts are ipmns, a subset of which may be. Pancreatic cyst fluid dna analysis that includes identification of kras2 gene mutations is being explored for predicting the aggressiveness of pancreatic cysts. Collect cyst fluid 200600 ul into vials containing preservative obtained from the upmc molecular laboratory. L of cyst fluid by column separation and according to the manufacturers directions and instructions qiagen. Some pancreatic cysts are true cysts noninflammatory cysts, that is, they are lined by a special layer of cells that are responsible for secreting fluid into the cysts. Pancreatic cyst fluid dna analysis in evaluating pancreatic cysts. Statistical analysis was performed using r statistical software. Cyst fluid can be analyzed for tumor markers, cytology, mucins, dna analysis and amylase. Dna mutational analysis of pancreatic cystic fluid cf is a useful adjunct to. Download scientific diagram typical pancreatic cyst fluid analysis findings from. To examine the utility of integrated molecular pathology imp in managing surveillance of pancreatic cysts based on outcomes and analysis of false negatives fns from a previously published cohort n492. Methods patient samples and pancreatic cyst fluid collection a cohort of 69 patients with suspected cystic lesions was established between the period of 2008 and 20 table 1 and additional file 1.
The aim of the present study was to assess the diagnostic utility and clinical value of carcinoembryonic antigen cea, carbohydrate antigen 199 ca 19. Th e cost of cyst analysis and cyst surveillance is high, and the benefi t in terms of cancer prevention is unproven. Diagnostic ability of artificial intelligence using deep. Biomarker predicts which pancreatic cysts may become cancerous. A large cystic pancreatic mass in a 45yearold female. The research team collected fluid from the cysts of 169 patients who had surgery to remove the pancreatic cysts. Of these, 106 were pathologically confirmed as mucinous 25 mcns, 77 ipmns, 4 ductal adenocarcinomas and 47 as nonmucinous cysts 21 scns, 9 cystic neuroendocrine tumors, 14 pseudocysts, and 3 solid pseudopapillary neoplasms. Pancreatic cyst fluid ngs analysis pancreaseq west. The test isnt precise, however, since the ca199 level can rise in response to noncancerous conditions such as pancreatitis.
Similarly, pancreatic cyst fluid markers have a wide range of diagnostic accuracies for the. Analysis of proteins and genes in cyst fluid helps diagnostically, but prior biomarkers had limited ability to detect highrisk cases. Pancreatic cyst fluid analysis provides important information that can be used to improve the. Learn which tests distinguish pancreatic cancer from pseudocyst. Pancreatic cysts can either be neoplastic eg, intraductal papillary mucinous neoplasms or nonneoplastic. Pancreatic cysts are saclike pockets of fluid that develop on or in the pancreas. Dr lowenfels comments on a study that examines whether four protein markers present in the pancreatic cyst fluid increased the predictive accuracy of detecting a highrisk ipmn. Pancreatic cyst fluid analysis for differential diagnosis. Label vial with 2 patient identifiers and send sample to wvuh main laboratory specimen processing asap sample must not remain at room temperature 3 hrs or at 4c 24 hrs. Cyst fluid telomerase activity predicts the histologic grade.
Second, these studies show that the volume of required cyst fluid for analysis is minute 6400 microliters and easily obtainable by endoscopic ultrasound even from cysts less than 1 cm in diameter. Patient samples and pancreatic cyst fluid collection. Pancreatic cysts can occur in the setting of pancreatitis, though they are only reliably diagnosed 6 weeks after the episode of acute pancreatitis. In endoscopic ultrasound with fineneedle aspiration eusfna of cyst fluid lacking malignant cytology, imp demonstrated better risk stratification for malignancy at. The role of molecular analysis in the diagnosis and. Amylases are a group of hydrolases that degrade complex carbohydrates into fragments. Cyst fluid was opera tively obtained in the largest yet reported study 7 the. Differentiation of pancreatic cyst types by analysis of. Morton jm, brown a, galanko ja, norton ja, grimm is, behrns ke. Cyst fluid analysis in the differential diagnosis of pancreatic cysts. Fluid analysis prior to surgical resection of suspected. All statistical analyses were performed using the spss statistical software. Preoperative gnas and kras testing in the diagnosis of. The majority of pancreatic cysts are detected incidentally when abdominal imaging is performed during unrelated procedures.
A cohort of 69 patients with suspected cystic lesions was established between the period of 2008 and 20 table 1 and additional file 1. Pancreatic cyst fluid analysis has an important role in diagnosis, although all currently available investigations based on fluid analysis have significant limitations. The presence of extracellular mucin in aspirated cyst fluid is moderately predictive of a mucinous. Pancreatic cysts can be either simple retention cysts, pseudocysts and cystic neoplasms, while these are further subdivided into serous cystadenomas. Here is some info from ohio state improving lives through excellence in research, education and patient care. She underwent an abdominal ultrasound, which revealed a large cystic abdominal mass. It is also produced by the small intestine mucosa, ovaries, placenta, liver, and fallopian tubes.
We evaluated the utility of cystfluid molecular analysis, including mutational analysis of kras, loss of heterozygosity loh at tumor suppressor loci, and dna content in the diagnoses and surveillance of pancreatic cysts. On one hand, cysts with highgrade dysplasia offer opportunities for cure, on the other hand, those with lowgrade dysplasia are easily over treated. The presence of extracellular mucin in aspirated cyst fluid. Endoscopic ultrasoundguided fine needle aspiration and cyst fluid analysis for pancreatic cysts siriboon attasaranya, shireen pais, julia leblanc, lee mchenry, stuart sherman. The present study aimed to investigate the value of gnas testing when added to kras and carcinoembryonic antigen cea testing of pcf for the diagnosis of intraductal papillary mucinous neoplasms ipmn. Typical pancreatic cyst fluid analysis findings download scientific. The pancreatic cyst fluids pcf were collected after a.
In addition to providing expert imaging services, msk pathologists are leaders in analyzing fluid in pancreatic cysts and determining if and what type of cancer cells might be present. In an attempt to develop new preoperative diagnostic criteria to assist in decisions regarding therapy, the authors have performed cyst fluid analysis for tumor markers carcinoembryonic antigen. Pancreatic cyst fluids pcfs enriched in tumourderived proteins are. Diagnosis and management of cystic pancreatic lesions. A national comparison of surgical versus percutaneous drainage of.
Learn about pancreatic cyst symptoms, surgery and care here at ohio state. Cyst fluid analysis in pancreatic intraductal papillary. Using decisionanalysis software, the research team evaluated a set of hypothetical patients ranging in age from 65 to 85 with a variety of asymptomatic pancreatic cysts, ranging in size from half. Genomic profile concordance between pancreatic cyst fluid and. A volume based protocol using different components of the 1 specimen for cytology, carcinoembryonic antigen and v. Management decisions for pancreatic cysts must take into account their low risk of malignancy vs. The results of cyst fluid analysis should be used in combination with clinical history and imaging to help guide management decisions. In the current study, the investigators examined the use of pancreatic cyst fluid molecular analysis in combination with standard diagnostic criteria imp in the hopes of establishing a more accurate diagnostic test to assess the malignant potential of pancreatic. Endoscopic ultrasound eusguided fine needle aspiration fna cytology and molecular analysis of these cystic lesions have led to their better detection and characterization. Test shown to improve accuracy in identifying precancerous. In a multivariate analysis, pancreatic cyst fluid kras mutation was the only component of cyst fluid analysis associated with nonindolent behavior including resection of a mucinous cyst, cyst progression, development of malignancy and death due to pancreatic cancer. Use of cyst fluid cea, ca199, and amylase for evaluation. Cyst fluid concentrations of cea, ca199, ca125, and amylase were. Mascot results processing was done using mscan software available at.
The cost of cyst analysis and cyst surveillance is high, and the benefit in terms of cancer prevention is unproven. Pancreatic cyst cea level is considered the most accurate tumor marker for diagnosing mucinous cysts. A pancreatic pseudocyst is a circumscribed collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue, typically located in the lesser sac of the abdomen. Pancreatic intraductal papillary mucinous neoplasms ipmn are surgically treatable cancer precursors, if highrisk features can be identified. Analysis of pancreatic cyst fluid has become an important part of the investigation and classification of pancreatic cysts. Objective dnabased testing of pancreatic cyst fluid pcf is a useful adjunct to the. Ercp endoscopic retrograde cholangiopancreatography enables the doctor to view the structure of the common bile duct, other bile ducts, and the pancreatic duct. Collection vials at room temperature in the dark before use. These blood tests can help us determine whether your cyst is benign noncancerous or precancerous. Mass spectrometrybased comprehensive analysis of pancreatic. Value of adding gnas testing to pancreatic cyst fluid kras. While we wait for these developments, what can cyst fluid analysis tell the clinician about a pancreatic cyst today. Eusfna cytology and fluid analysis are frequently utilized to evaluate pancreatic cysts.
Optimizing the multimodal approach to pancreatic cyst fluid. Endoscopic ultrasound with fine needle aspiration and cyst fluid analysis categorizes cysts and defines highrisk features for cancer. Context molecular analysis of pancreatic cyst fluid obtained by eusfna may increase diagnostic accuracy. Preoperative nextgeneration sequencing of pancreatic cyst fluid is. Given our ability to aspirate fluid safely and effectively from pancreatic cysts, the most logical tool lies in the development of a cyst fluid biomarker. Aug 17, 2012 in a multivariate analysis, pancreatic cyst fluid kras mutation was the only component of cyst fluid analysis associated with nonindolent behavior including resection of a mucinous cyst, cyst progression, development of malignancy and death due to pancreatic cancer. Pancreatic cysts are collections pools of fluid that can form within the head, body, and tail of the pancreas. Dec 11, 2017 lewandrowski kb, southern jf, pins mr, compton cc, warshaw al.
The patient is an otherwise healthy 45yearold female who presented to her primary care physician with 6 weeks of increasing left upper quadrant abdominal pain with radiation to the back. Endoscopic ultrasound eusguided fine needle aspiration fna cytology and molecular analysis of these cystic lesions have led to. Acute peripancreatic fluid collection radiology reference. Simple pancreatic cysts, also known as true epithelial cysts or retention cysts, are unilocular cysts within the pancreas, lined by a monolayer of epithelium, which lack communication with the pancreatic ducts 1,5. Pancreatic cyst fluid was taken for analysis of cea, ca199, ca125, and amylase 10.
A total of 153 pancreatic cyst fluid samples were collected and analyzed for study inclusion. Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions. Pancreatic cysts frequently pose clinical dilemmas. New tool developed to help guide pancreatic cyst treatment. Pancreatic cyst fluid harbors a unique microbiome microbiome. Pancreatic cyst fluid analysis provides important information that can be used to improve the diagnosis of pancreatic cysts. Eusfna cytology and cyst fluid analysis is a useful adjunct to abdominal imaging for the diagnosis of pancreatic cystic lesions. Amylase may be helpful in differentiating pseudocyst from serous cystadenoma. Because telomerase activity is commonly activated in malignant cells, we evaluated the diagnostic.
Abstract pancreatic cysts involve a wide spectrum of pathologies from post. Pancreatic cyst diagnosis memorial sloan kettering cancer. Mar 30, 2017 differentiation of pancreatic cyst types by analysis of rheological behavior of pancreatic cyst fluid skip to main content thank you for visiting. The researchers analyzed the fluid, using a test to detect the das1. Using decision analysis software, the research team evaluated a set of hypothetical patients ranging in age from 65 to 85 with a variety of asymptomatic pancreatic cysts, ranging in. A comparison of pseudocysts, serous cystadenomas, mucinous cystic neoplasms, and mucinous cystadenocarcinoma. Simple pancreatic cyst radiology reference article. Analysis of possible falsenegative cases of malignancy.
Analysis of cyst fluids for tumor markers such as cea and ca199, or pancreas specific analytes like the digestive enzyme amylase, has the potential to improve diagnosis of pancreatic lesions. Pancreatic cysts are common, and are identified in 2% of. There have been no dedicated cost effectiveness analyses about surveillance of incidental pancreatic cysts. Alrashdan a, schmidt c, alhaddad m, mchenry l, leblanc j, sherman s, dewitt j. Measurement of amylase in pancreatic cyst fluid is often used in conjunction with tumor markers. Pancreatic cyst diagnosis memorial sloan kettering. Using cyst fluid obtained during eus, it is possible to measure tumor marker concentrations in the actual lesion contents. If you or someone you care about has been recently diagnosed with a cyst of the pancreas, you are not alone. An increased number of pancreatic cysts are beingdiagnosed due to the increased usage of crosssectional imaging. An increased number of pancreatic cysts are being diagnosed due to the increased usage of crosssectional imaging. The results of cyst fluid analysis should be used in. This test measures the level of a protein in the blood or cyst fluid that may be higher if a cyst is precancerous. Using decision analysis software, the research team evaluated a set of hypothetical patients ranging in age from 65 to 85 with a variety of asymptomatic pancreatic cysts, ranging in size from half. Stratifying intraductal papillary mucinous neoplasms by cyst fluid.
In general, the higher the cea value, the more likely the cyst is a mucinous cyst, with the associated risk of malignancy. Cyst fluid telomerase activity predicts the histologic. Endoscopic ultrasoundguided fine needle aspiration and. The presence of extracellular mucin in the cyst fluid aspirate is an independent predictor for the diagnosis of a mucinous cyst, with a specificity that approaches 100%, a sensitivity approaching 80%, and a positive predictive value of 83%. Update on pancreatic cyst fluid analysis 3 annals of gastroenterology 25 muc staining has been reported 32. Pancreatic cyst and cancer early detection center pccedc the mission of the pccedc is to promote early detection and prevent pancreatic cancer through rigorous identification, tracking and treatment of patients at risk for pancreatic cancer through a multidisciplinary screening clinic, registry, community outreach, education and research discovery. Fluid from serous cystadenomas often has cea values fluid with increased cea due to the mucinous ining of these cysts. Theres usually no definitive cause, although pancreatitis can cause the cysts. Jul 17, 2019 using information from more than 800 patients with pancreatic cysts who had cyst fluid analysis and cyst removal surgery at the johns hopkins hospital and 15 other medical centers around the world. Pancreatic cyst cea level is considered the most accurate tumor. Pancreaseq detects single nucleotide variants snvs and insertionsdeletions indels in targeted regions of 20 pancreatic cancerrelated genes, and copy number alterations in 4 genes. Although cystic neoplasms of the pancreas are rare, differentiation is important in determining the proper.
Pancreatic cysts and pseudocysts diagnosis and tests. Pancreatic cyst fluid analysis 177 effective and can be performed quickly. Pancreatic cysts are fluid filled, saclike lesions occurring in the pancreas. Cyst fluid markers have the potential to improve the evaluation of these cysts. Molecular analysis of pancreatic cyst fluid pcf has been proposed as a novel method for differentiating pancreatic cystic lesions pcl. Amylase is produced by the exocrine pancreas and the salivary glands to aid in the digestion of starch. Endoscopic ultrasoundguided fine needle aspiration and cyst fluid analysis for pancreatic cysts siriboon attasaranya, shireen pais, julia leblanc, lee mchenry, stuart sherman, john m dewitt department of medicine, division of gastroenterology and hepatology, indiana university school of medicine. Dec 11, 2017 pancreatic pseudocysts see the image below are best defined as localized fluid collections that are rich in amylase and other pancreatic enzymes, that have a nonepithelialized wall consisting of fibrous and granulation tissue, and that usually appear several weeks after the onset of pancreatitis. Fluid analysis prior to surgical resection of suspected mucinous pancreatic cysts. Elevated cyst fluid cea is usually indicative of a mucinous pancreatic cyst but whether cea or amylase values can subclassify various mucinous cysts is unknown. Aspiration and cyst fluid analysis for pancreatic cysts, siriboon attasaranya.