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Role of endoscopic ultrasound and cyst fluid tumor markers in diagnosis of pancreatic cystic lesions
BACKGROUND: Pancreatic cystic lesions (PCLs) are common in clinical practice. The accurate classification and diagnosis of these lesions are crucial to avoid unnecessary treatment of benign lesions and missed opportunities for early treatment of potentially malignant lesions. AIM: To evaluate the ro...
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Formaat: | Online Artikel Texto |
Taal: | English |
Gepubliceerd in: |
Baishideng Publishing Group Inc
2022
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Onderwerpen: | |
Online toegang: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9265252/ https://www.ncbi.nlm.nih.gov/pubmed/35978716 http://dx.doi.org/10.4253/wjge.v14.i6.402 |
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author | Okasha, Hussein Hassan Abdellatef, Abeer Elkholy, Shaimaa Mogawer, Mohamad-Sherif Yosry, Ayman Elserafy, Magdy Medhat, Eman Khalaf, Hanaa Fouad, Magdy Elbaz, Tamer Ramadan, Ahmed Behiry, Mervat E Y William, Kerolis Habib, Ghada Kaddah, Mona Abdel-Hamid, Haitham Abou-Elmagd, Amr Galal, Ahmed Abbas, Wael A Altonbary, Ahmed Youssef El-Ansary, Mahmoud Abdou, Aml E Haggag, Hani Abdellah, Tarek Ali Elfeki, Mohamed A Faheem, Heba Ahmed Khattab, Hani M El-Ansary, Mervat Beshir, Safia El-Nady, Mohamed |
author_facet | Okasha, Hussein Hassan Abdellatef, Abeer Elkholy, Shaimaa Mogawer, Mohamad-Sherif Yosry, Ayman Elserafy, Magdy Medhat, Eman Khalaf, Hanaa Fouad, Magdy Elbaz, Tamer Ramadan, Ahmed Behiry, Mervat E Y William, Kerolis Habib, Ghada Kaddah, Mona Abdel-Hamid, Haitham Abou-Elmagd, Amr Galal, Ahmed Abbas, Wael A Altonbary, Ahmed Youssef El-Ansary, Mahmoud Abdou, Aml E Haggag, Hani Abdellah, Tarek Ali Elfeki, Mohamed A Faheem, Heba Ahmed Khattab, Hani M El-Ansary, Mervat Beshir, Safia El-Nady, Mohamed |
author_sort | Okasha, Hussein Hassan |
collection | PubMed |
description | BACKGROUND: Pancreatic cystic lesions (PCLs) are common in clinical practice. The accurate classification and diagnosis of these lesions are crucial to avoid unnecessary treatment of benign lesions and missed opportunities for early treatment of potentially malignant lesions. AIM: To evaluate the role of cyst fluid analysis of different tumor markers such as cancer antigens [e.g., cancer antigen (CA)19-9, CA72-4], carcinoembryonic antigen (CEA), serine protease inhibitor Kazal-type 1 (SPINK1), interleukin 1 beta (IL1-β), vascular endothelial growth factor A (VEGF-A), and prostaglandin E2 (PGE2)], amylase, and mucin stain in diagnosing pancreatic cysts and differentiating malignant from benign lesions. METHODS: This study included 76 patients diagnosed with PCLs using different imaging modalities. All patients underwent endoscopic ultrasound (EUS) and EUS-fine needle aspiration (EUS-FNA) for characterization and sampling of different PCLs. RESULTS: The mean age of studied patients was 47.4 ± 11.4 years, with a slight female predominance (59.2%). Mucin stain showed high statistical significance in predicting malignancy with a sensitivity of 87.1% and specificity of 95.56%. It also showed a positive predictive value and negative predictive value of 93.1% and 91.49%, respectively (P < 0.001). We found that positive mucin stain, cyst fluid glucose, SPINK1, amylase, and CEA levels had high statistical significance (P < 0.0001). In contrast, IL-1β, CA 72-4, VEGF-A, VEGFR2, and PGE2 did not show any statistical significance. Univariate regression analysis for prediction of malignancy in PCLs showed a statistically significant positive correlation with mural nodules, lymph nodes, cyst diameter, mucin stain, and cyst fluid CEA. Meanwhile, logistic multivariable regression analysis proved that mural nodules, mucin stain, and SPINK1 were independent predictors of malignancy in cystic pancreatic lesions. CONCLUSION: EUS examination of cyst morphology with cytopathological analysis and cyst fluid analysis could improve the differentiation between malignant and benign pancreatic cysts. Also, CEA, glucose, and SPINK1 could be used as promising markers to predict malignant pancreatic cysts. |
format | Online Article Text |
id | pubmed-9265252 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-92652522022-08-16 Role of endoscopic ultrasound and cyst fluid tumor markers in diagnosis of pancreatic cystic lesions Okasha, Hussein Hassan Abdellatef, Abeer Elkholy, Shaimaa Mogawer, Mohamad-Sherif Yosry, Ayman Elserafy, Magdy Medhat, Eman Khalaf, Hanaa Fouad, Magdy Elbaz, Tamer Ramadan, Ahmed Behiry, Mervat E Y William, Kerolis Habib, Ghada Kaddah, Mona Abdel-Hamid, Haitham Abou-Elmagd, Amr Galal, Ahmed Abbas, Wael A Altonbary, Ahmed Youssef El-Ansary, Mahmoud Abdou, Aml E Haggag, Hani Abdellah, Tarek Ali Elfeki, Mohamed A Faheem, Heba Ahmed Khattab, Hani M El-Ansary, Mervat Beshir, Safia El-Nady, Mohamed World J Gastrointest Endosc Observational Study BACKGROUND: Pancreatic cystic lesions (PCLs) are common in clinical practice. The accurate classification and diagnosis of these lesions are crucial to avoid unnecessary treatment of benign lesions and missed opportunities for early treatment of potentially malignant lesions. AIM: To evaluate the role of cyst fluid analysis of different tumor markers such as cancer antigens [e.g., cancer antigen (CA)19-9, CA72-4], carcinoembryonic antigen (CEA), serine protease inhibitor Kazal-type 1 (SPINK1), interleukin 1 beta (IL1-β), vascular endothelial growth factor A (VEGF-A), and prostaglandin E2 (PGE2)], amylase, and mucin stain in diagnosing pancreatic cysts and differentiating malignant from benign lesions. METHODS: This study included 76 patients diagnosed with PCLs using different imaging modalities. All patients underwent endoscopic ultrasound (EUS) and EUS-fine needle aspiration (EUS-FNA) for characterization and sampling of different PCLs. RESULTS: The mean age of studied patients was 47.4 ± 11.4 years, with a slight female predominance (59.2%). Mucin stain showed high statistical significance in predicting malignancy with a sensitivity of 87.1% and specificity of 95.56%. It also showed a positive predictive value and negative predictive value of 93.1% and 91.49%, respectively (P < 0.001). We found that positive mucin stain, cyst fluid glucose, SPINK1, amylase, and CEA levels had high statistical significance (P < 0.0001). In contrast, IL-1β, CA 72-4, VEGF-A, VEGFR2, and PGE2 did not show any statistical significance. Univariate regression analysis for prediction of malignancy in PCLs showed a statistically significant positive correlation with mural nodules, lymph nodes, cyst diameter, mucin stain, and cyst fluid CEA. Meanwhile, logistic multivariable regression analysis proved that mural nodules, mucin stain, and SPINK1 were independent predictors of malignancy in cystic pancreatic lesions. CONCLUSION: EUS examination of cyst morphology with cytopathological analysis and cyst fluid analysis could improve the differentiation between malignant and benign pancreatic cysts. Also, CEA, glucose, and SPINK1 could be used as promising markers to predict malignant pancreatic cysts. Baishideng Publishing Group Inc 2022-06-16 2022-06-16 /pmc/articles/PMC9265252/ /pubmed/35978716 http://dx.doi.org/10.4253/wjge.v14.i6.402 Text en ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. |
spellingShingle | Observational Study Okasha, Hussein Hassan Abdellatef, Abeer Elkholy, Shaimaa Mogawer, Mohamad-Sherif Yosry, Ayman Elserafy, Magdy Medhat, Eman Khalaf, Hanaa Fouad, Magdy Elbaz, Tamer Ramadan, Ahmed Behiry, Mervat E Y William, Kerolis Habib, Ghada Kaddah, Mona Abdel-Hamid, Haitham Abou-Elmagd, Amr Galal, Ahmed Abbas, Wael A Altonbary, Ahmed Youssef El-Ansary, Mahmoud Abdou, Aml E Haggag, Hani Abdellah, Tarek Ali Elfeki, Mohamed A Faheem, Heba Ahmed Khattab, Hani M El-Ansary, Mervat Beshir, Safia El-Nady, Mohamed Role of endoscopic ultrasound and cyst fluid tumor markers in diagnosis of pancreatic cystic lesions |
title | Role of endoscopic ultrasound and cyst fluid tumor markers in diagnosis of pancreatic cystic lesions |
title_full | Role of endoscopic ultrasound and cyst fluid tumor markers in diagnosis of pancreatic cystic lesions |
title_fullStr | Role of endoscopic ultrasound and cyst fluid tumor markers in diagnosis of pancreatic cystic lesions |
title_full_unstemmed | Role of endoscopic ultrasound and cyst fluid tumor markers in diagnosis of pancreatic cystic lesions |
title_short | Role of endoscopic ultrasound and cyst fluid tumor markers in diagnosis of pancreatic cystic lesions |
title_sort | role of endoscopic ultrasound and cyst fluid tumor markers in diagnosis of pancreatic cystic lesions |
topic | Observational Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9265252/ https://www.ncbi.nlm.nih.gov/pubmed/35978716 http://dx.doi.org/10.4253/wjge.v14.i6.402 |
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