Long-term validation of intra-cystic biomarkers for pancreatic cysts

Abstract

Background: Pancreatic Cyst Lesions (PCLs) are frequently diagnosed in radiologic imaging tests and can be classified as benign, premalignant and malignant. Their correct stratification is essential and has significant implications for the patient. The objective of the study was to determine the clinical and analytical characteristics that can help in their differential diagnosis.

Methods: This observational retrospective study included patients with PCLs diagnosed by endoscopic ultrasound from 2011 to 2023. Data collected included age, sex, personal history, treatments, toxic habits, family history of cancer, body mass index, and radiological and serological findings. The following intra-cyst levels were gathered: glucose, amylase, lipase, CEA and CA19.9.

Results: 271 patients with PCLs were included, 93 (35%) of them were benign, 55 (20%) were premalignant, and 123 (45%) malignant. Serous cystadenomas were the most common benign lesion in 71 (76%) patients. Within the premalignant group, intraductal papillary mucinous neoplasms (IPMNs) were the most common in 85% (47) patients. Cystic adenocarcinoma was the most prevalent malignant PCLs in 102 (83%) patients. Intra-cystic CEA value was the only parameter able to differentiate benign from malignant/premalignant lesions. Thirty (11%) patients underwent surgery with a final diagnosis of a malignant lesion in 13 (43%) patients, premalignant lesions in 5 (23%) (4 IPMNs and 1 mucinous cystadenoma) and benign cysts in 12 (40%). Five (38%) of the 13 malignant lesions were diagnosed at stages III/IV.

Conclusion: Intra-cyst CEA values can help us to classify premalignant PCNs. However, additional biomarkers and clinical parameters are required to better discriminate patients at the time of PCLs detection.

Keywords: CA19.9; CEA; Malignancy; Pancreatic cyst lesions; U endoscopy.