COMMENTARY

Pancreatic Cyst Fluid Analysis: Predictor of Malignancy?

Albert B. Lowenfels, MD

Disclosures

August 16, 2018

Can analysis of the fluid within a pancreatic cyst help decisions regarding whether an intraductal papillary mucinous neoplasm (IPMN) is likely to be malignant? A multicenter study, published in Annals of Surgery , was based on 149 operated patients stratified by clinical, radiographic, and pathologic findings into a high-risk group where high-grade dysplasia or invasive cancer was present (n = 60) or a low-risk group (n = 89).[1]

The study also included measurement of four protein markers present in the cyst fluid. All four proteins were overexpressed in the high-risk versus the low-risk group (P < .001). Adding the findings of the protein analysis to a prediction model based on clinical and radiologic findings increased the predictive accuracy of detecting a high-risk IPMN.

Will a Biological Marker Be Available in the Foreseeable Future?

Pancreatic cysts are common pancreatic abnormalities found in up to 50% of adults[2] and are often discovered as "incidentalomas" when a patient receives a CT or an MRI study.

Managing these potentially malignant lesions is a major clinical problem because cysts that harbor an IPMN can subsequently develop pancreatic cancer. Current guidelines for managing IPMNs rely on clinical or radiologic findings to help the surgeon decide whether or not to perform pancreatic surgery.[3] However, as the authors point out, current guidelines can lead to unnecessary pancreatic surgery.

The addition of a biological marker based on the protein content of aspirated cyst fluid could improve the detection rate for premalignant lesions. At present, however, the protein test described by the authors for analyzing cyst fluid is not commercially available. Until commercial tests do become available, surgeons will have to rely on existing guidelines to help decide whether or not to operate.

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