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Cyst fluid metabolites distinguish malignant from benign pancreatic cysts.
- Source :
-
Neoplasia (New York, N.Y.) [Neoplasia] 2021 Nov; Vol. 23 (11), pp. 1078-1088. Date of Electronic Publication: 2021 Sep 25. - Publication Year :
- 2021
-
Abstract
- Objectives: Current standard of care imaging, cytology, or cystic fluid analysis cannot reliably differentiate malignant from benign pancreatic cystic neoplasms. This study sought to determine if the metabolic profile of cystic fluid could distinguish benign and malignant lesions, as well as mucinous and non-mucinous lesions.<br />Methods: Metabolic profiling by untargeted mass spectrometry and quantitative nuclear magnetic resonance was performed in 24 pancreatic cyst fluid from surgically resected samples with pathological diagnoses and clinicopathological correlation.<br />Results: (Iso)-butyrylcarnitine distinguished malignant from benign pancreatic cysts, with a diagnostic accuracy of 89%. (Iso)-butyrylcarnitine was 28-fold more abundant in malignant cyst fluid compared with benign cyst fluid (P=.048). Furthermore, 5-oxoproline (P=.01) differentiated mucinous from non-mucinous cysts with a diagnostic accuracy of 90%, better than glucose (82% accuracy), a previously described metabolite that distinguishes mucinous from non-mucinous cysts. Combined analysis of glucose and 5-oxoproline did not improve the diagnostic accuracy. In comparison, standard of care cyst fluid carcinoembryonic antigen (CEA) and cytology had a diagnostic accuracy of 40% and 60% respectively for mucinous cysts. (Iso)-butyrylcarnitine and 5-oxoproline correlated with cyst fluid CEA levels (P<.0001 and P<.05 respectively). For diagnosing malignant pancreatic cysts, the diagnostic accuracies of cyst size > 3 cm, ≥ 1 high-risk features, cyst fluid CEA, and cytology are 38%, 75%, 80%, and 75%, respectively.<br />Conclusions: (Iso)-butyrylcarnitine has potential clinical application for accurately distinguishing malignant from benign pancreatic cysts, and 5-oxoproline for distinguishing mucinous from non-mucinous cysts.<br /> (Copyright © 2021. Published by Elsevier Inc.)
- Subjects :
- Adenocarcinoma, Mucinous metabolism
Adult
Aged
Diagnosis, Differential
Female
Follow-Up Studies
Humans
Male
Middle Aged
Pancreatic Cyst metabolism
Pancreatic Neoplasms metabolism
Prognosis
Adenocarcinoma, Mucinous diagnosis
Biomarkers, Tumor metabolism
Cyst Fluid metabolism
Metabolome
Pancreatic Cyst diagnosis
Pancreatic Neoplasms diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1476-5586
- Volume :
- 23
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Neoplasia (New York, N.Y.)
- Publication Type :
- Academic Journal
- Accession number :
- 34583246
- Full Text :
- https://doi.org/10.1016/j.neo.2021.09.004