Endoscopy 2020; 52(S 01): S55-S56
DOI: 10.1055/s-0040-1704173
ESGE Days 2020 oral presentations
Thursday, April 23, 2020 16:30 – 18:00 Pancreatic cystic lesions Liffey Hall 1
© Georg Thieme Verlag KG Stuttgart · New York

GLUCOSE LEVELS IN EUS-ASPIRATED CYST FLUID HAVE A HIGH ACCURACY FOR THE DIAGNOSIS OF MUCINOUS PANCREATIC CYSTIC LESIONS

G Rossi
1   Pancreas Translational and Clinical Research Center San Raffaele Scientific Institute IRCCS Vita Salute San Raffaele University, Pancreato-Biliary Endoscopy and Endosonography Division, Milan, Italy
,
G Capurso
1   Pancreas Translational and Clinical Research Center San Raffaele Scientific Institute IRCCS Vita Salute San Raffaele University, Pancreato-Biliary Endoscopy and Endosonography Division, Milan, Italy
,
MC Petrone
1   Pancreas Translational and Clinical Research Center San Raffaele Scientific Institute IRCCS Vita Salute San Raffaele University, Pancreato-Biliary Endoscopy and Endosonography Division, Milan, Italy
,
M Locatelli
2   Pancreas Translational and Clinical Research Center San Raffaele Scientific Institute IRCCS Vita Salute San Raffaele University, Biochemistry Department, Milan, Italy
,
S Crippa
3   Pancreas Translational and Clinical Research Center San Raffaele Scientific Institute IRCCS Vita Salute San Raffaele University, Surgical Department, Milan, Italy
,
C Doglioni
4   Pancreas Translational and Clinical Research Center San Raffaele Scientific Institute IRCCS Vita Salute San Raffaele University, Pathology Department, Milan, Italy
,
A Mariani
1   Pancreas Translational and Clinical Research Center San Raffaele Scientific Institute IRCCS Vita Salute San Raffaele University, Pancreato-Biliary Endoscopy and Endosonography Division, Milan, Italy
,
SGG Testoni
1   Pancreas Translational and Clinical Research Center San Raffaele Scientific Institute IRCCS Vita Salute San Raffaele University, Pancreato-Biliary Endoscopy and Endosonography Division, Milan, Italy
,
L Archibugi
1   Pancreas Translational and Clinical Research Center San Raffaele Scientific Institute IRCCS Vita Salute San Raffaele University, Pancreato-Biliary Endoscopy and Endosonography Division, Milan, Italy
,
PG Arcidiacono
1   Pancreas Translational and Clinical Research Center San Raffaele Scientific Institute IRCCS Vita Salute San Raffaele University, Pancreato-Biliary Endoscopy and Endosonography Division, Milan, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    Aims Differential diagnosis(DD)between mucinous(M) and non-mucinous(NM) pancreatic cystic lesions(PCLs) is fundamental for appropriate patients’management. CEA levels>192 ng/ml are considered suggestive of mucinous cysts(MC), yet with limited accuracy. Recent studies have suggested that low intracystic glucose levels are associated with MC.

    Aim of the study was to assess diagnostic accuracy of intracystic glucose as compared to CEA levels in EUS obtained cyst fluid to differentiate MPCLs vs NMPCLs.

    Methods We prospectively enrolled PCLs-EUS+FNA(22G-needle) from July2018 to October2019. Glucose and CEA levels were examined in hospital laboratory with same methods as for circulating levels. All the samples were evaluated by expert cytopathologists with rapid on site evaluation(ROSE). Glucose and CEA diagnostic accuracy was evaluated considering as “gold standard” the pathology report in case of surgery, FNA cytological report and/or imaging features(MRI,EUS) in other cases as agreed by 2expert pancreatologists blind to PCLs fluid analysis.

    Results 48patients with PCLs were enrolled(mean age60, cysts mean size46 mm).

    Final diagnosis, based on surgical pathology in 6cases, on EUS-cytology in 15cases and on endoscopic/imaging data in the remaining 27cases, was of MPCLs in 50%(IPMNs), serous cystic adenomas in 33,3%, pseudocyst in 4,2%, cystic neuroendocrine tumors in 4.2%(Ki67:2%and3%respectively) and mesenterial cyst, simple cyst and Schwannoma in 1case each.

    Mean intracystic glucose level was 13mg/dl(95% 2.2-24) in MPCLs and 93.6mg/dl(95% CI 84.2-102.9) in NMPCLs(p< 0.0001).

    At ROC curve the best glucose cut-off to distinguish M-and NM-PCLs was 30mg/dl. Intracystic glucose≤30mg/dL showed an AUC of 0.95(CI 0.85-0.99), with 91.3%sensitivity and 100%specificity.

    AUC for CEA≥192 ng/ml was 0.69(CI 0.54-0.81) with sensitivity37.5% and specificity100%.

    There was no correlation between glucose levels and cyst-size or CEA-levels.

    Conclusions Intracystic glucose dosage of cyst fluid obtained during EUS-FNA represents a valid and simple tool for M-vs NM-PCLs DD,being more accurate than CEA levels. Mechanisms leading to different glucose levels in different cyst types remain unexplored.


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