Stratifying Intraductal Papillary Mucinous Neoplasms by Cyst Fluid Analysis: Present and Future

A significant proportion of patients with intraductal papillary mucinous neoplasms (IPMNs) undergo surgical resection in order to prevent or treat pancreatic cancer at the risk of significant perioperative morbidity. Efforts have been made to stratify the potential risk of malignancy based on the clinical and radiographic features of IPMN to delineate which cysts warrant resection versus observation. An analysis of the cyst fluid obtained by preoperative endoscopic examination appears to be correlative of cyst type and risk, whereas serum markers and radiographic findings have not yet reached a level of sensitivity or specificity that proves they are clinically meaningful. In this review, we investigate the current cyst fluid analysis studies and present those that have shown promise in effectively stratifying high-risk versus low-risk lesions. While new cyst fluid markers continue to be identified, additional efforts in testing panels and marker composites in conjunction with clinical algorithms have also shown promise in distinguishing dysplasia and the risk of malignancy. These should be tested prospectively in order to determine their role in guiding the surveillance of low-risk lesions and to evaluate the new markers detected by proteomics and genetic sequencing.

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Cytological and Cyst Fluid Analysis of Small (≤3 cm) Branch Duct Intraductal Papillary Mucinous Neoplasms Adds Value to Patient Management Decisions

Pancreatology ◽

10.1159/000134276 ◽

2008 ◽

Vol 8 (3) ◽

pp. 277-284 ◽

Cited By ~ 67

Author(s):

Martha Bishop Pitman ◽

Paul J. Michaels ◽

Vikram Deshpande ◽

William R. Brugge ◽

Brenna C. Bounds

Keyword(s):

Patient Management ◽

Cyst Fluid ◽

Management Decisions ◽

Intraductal Papillary Mucinous Neoplasms ◽

Branch Duct ◽

Fluid Analysis ◽

Mucinous Neoplasms

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Cyst Fluid Analysis in Pancreatic Intraductal Papillary Mucinous Neoplasms

Clinical Cancer Research ◽

10.1158/1078-0432.ccr-16-1462 ◽

2016 ◽

Vol 22 (20) ◽

pp. 4966-4967 ◽

Cited By ~ 1

Author(s):

Peter J. Allen ◽

Christine A. Iacobuzio-Donahue ◽

David S. Klimstra

Keyword(s):

Cyst Fluid ◽

Intraductal Papillary Mucinous Neoplasms ◽

Fluid Analysis ◽

Mucinous Neoplasms

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Bioinformatic Analysis and Integration of Transcriptome and Proteome Results Identify Key Coding and Noncoding Genes Predicting Malignancy in Intraductal Papillary Mucinous Neoplasms of the Pancreas

BioMed Research International ◽

10.1155/2021/1056622 ◽

2021 ◽

Vol 2021 ◽

pp. 1-11

Author(s):

Barsha Saha ◽

Bishnupriya Chhatriya ◽

Swapnila Pramanick ◽

Srikanta Goswami

Keyword(s):

Gene Expression ◽

High Risk ◽

Target Genes ◽

Meta Analysis ◽

Cyst Fluid ◽

Low Risk ◽

Diagnostic Methods ◽

Intraductal Papillary Mucinous Neoplasms ◽

Potential Biomarker ◽

Mucinous Neoplasms

Background. Intraductal papillary mucinous neoplasms (IPMNs) are precursor lesions of pancreatic ductal adenocarcinoma (PDAC). IPMNs are generally associated with high risk of developing malignancy and therefore need to be diagnosed and assessed accurately, once detected. Existing diagnostic methods are inadequate, and identification of efficient biomarker capable of detecting high-risk IPMNs is necessitated. Moreover, the mechanism of development of malignancy in IPMNs is also elusive. Methods. Gene expression meta-analysis conducted using 12 low-risk IPMN and 23 high-risk IPMN tissue samples. We have also listed all the altered miRNAs and long noncoding RNAs (lncRNAs), identified their target genes, and performed pathway analysis. We further enlisted cyst fluid proteins detected to be altered in high-risk or malignant IPMNs and compared them with fraction of differentially expressed genes secreted into cyst fluid. Results. Our meta-analysis identified 270 upregulated and 161 downregulated genes characteristically altered in high-risk IPMNs. We further identified 61 miRNAs and 14 lncRNAs and their target genes and key pathways contributing towards understanding of the gene regulation during the progression of the disease. Most importantly, we have detected 12 genes altered significantly both in cystic lesions and cyst fluid. Conclusion. Our study reports, for the first time, a meta-analysis identifying key changes in gene expression between low-risk and high-risk IPMNs and also explains the regulatory aspect through construction of a miRNA-lncRNA-mRNA interaction network. The 12-gene-signature could function as potential biomarker in cyst fluid for detection of IPMN with a high risk of developing malignancy.

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