Multiinstitutional Validation Study of Cyst Fluid Protein Biomarkers in Patients With Cystic Lesions of the Pancreas.

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. 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). 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. 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. 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. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Citation

Caitlin A McIntyre, Clifton Rodrigues, Aadhithyaraman Vaithiya Santharaman, Debra A Goldman, Ammar A Javed, Debora Ciprani, Nan Pang, Anna Lokshin, Mithat Gonen, Mohammad A Al Efishat, Jin He, Richard Burkhart, William Burns, Matthew Weiss, Michael I D'Angelica, T Peter Kingham, Vinod P Balachandran, Jeffrey A Drebin, William R Jarnagin, Keith D Lillemoe, William Brugge, Brenna Casey, Anne Marie Lennon, Mark Schattner, Christopher L Wolfgang, Carlos Fernandez Del Castillo, Peter J Allen. Multiinstitutional Validation Study of Cyst Fluid Protein Biomarkers in Patients With Cystic Lesions of the Pancreas. Annals of surgery. 2022 Aug 01;276(2):e129-e132

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PMID: 34793354

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