Cyst Fluid Biomarkers for Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Critical Review from the International Expert Meeting on Pancreatic Branch-Duct-Intraductal Papillary Mucinous Neoplasms

Molecular Characterization and Pathogenesis of Intraductal Papillary Mucinous Neoplasms of the Pancreas

“…Maker et al [19] identified different cyst fluid glycoprotein and amylase expressions in IPMNs to distinguish between the major types of cystic neoplasms. They also identified CEA as a marker to differentiate between mucinous and nonmucinous pancreatic cystic lesions with a cutoff of 192 ng/ml, a sensitivity of 73%, a specificity of 84% and an accuracy of 79%.…”

“…The methylation of the suppressor of cytokine signaling-1 (SOCS-1) is associated with 22% of PDACs and 6% of IPMNs. Prostaglandin E 2 has to be validated as a reliable marker [19]. …”

“…The interleukin 1β expression, with a cutoff of 1.26 pg/ml, a sensitivity of 54.4-93.9% and a specificity of 76.2-99.9%, shows differences in high- and low-risk cysts [20]. Interleukin 5 and 8 expression is also higher in high-grade dysplasia and invasive carcinoma [19]. MUC5AC is specific to mucinous cysts, with a sensitivity of 78% and a specificity of 80%.…”

“…They identified GNAS (79%), KRAS (50%), RNF43 (14%), TP53 (10%) and BRAF (6%) as the most important mutations. Ten of the 13 detected mutations can be found in the tumors and cyst fluid samples [19]. …”

“…A mutation in the KRAS gene is followed by activation, desensitization and independence of growth factors [3]. KRAS is found in 40-86% of IPMNs (specificity 95% and sensitivity 45%) and in nearly 100% of PDAC in codon 12, 13 and 61 [3,8,19]. A combination of KRAS mutations and allelic loss is useful to distinguish malignant from benign cysts, with a specificity of 96% but a sensitivity of only 37% [19].…”