ARE BIOMARKERS IN PANCREATIC JUICE USEFUL TO DIFFERENTIATE BETWEEN CHRONIC PANCREATITIS AND IPMN WITH MAIN DUCT INVOLVEMENT?

Aims In patients with main pancreatic duct (MPD) dilation, differentiation between chronic pancreatitis (CP) and main-duct or mixed-type intraductal papillary mucinous neoplasia (IPMN) can be challenging. The aim of this study was to evaluate if biomarkers in pancreatic juice, including CEA, glucose and KRAS-mutations, can aid in the differentiation between CP and IPMN with MPD involvement.

Methods A single center pilot study with a post-hoc analysis was conducted in a prospective biobank of pancreatic juice samples from patients with either CP or IPMN with MPD involvement. All patients underwent pancreatic surgery between 2014 – 2020 and pancreatic juice was collected during surgery. CEA, glucose and mutations in KRAS were determined and compared between CP- and IPMN-samples.

Results Pancreatic juice samples were collected from 13 patients with CP and 29 patients with IPMN. KRAS-mutations were present in 9/12 CP- and 25/25 of IPMN patients (p=0.028). Median CEA (mmol/L) in pancreatic juice from CP patients (n=8) was 197.2 (IQR 388.3) and 209.0 (IQR 2039.8) in patients with IPMN (n=15, p=0.466). Median glucose (mg/dL) in CP patients (n=9) was 1.8 (IQR 1.35) and 2.7 (IQR 4.1) in patients with IPMN (n=15, p=0.815).

Table 1

Baseline characteristics	IPMN (n=29)	Chronic pancreatitis (n=13)
Male, n (%)	18 (62.1)	8 (61.5)
Age, mean (SD)	69.0 (7.2)	55.1 (8.5)
Diameter pancreatic duct (mm), mean (SD)	10.3 (3.9)	7.3 (2.6)

Fig. 1

Conclusions This pilot study could not confirm an added value of CEA and glucose in pancreatic juice to differentiate between CP and IPMN. Although the presence of a KRAS-mutation does not contribute to the discrimination between CP and IPMN, the absence of a KRAS mutations may be indicative for a chronic inflammatory cause of pancreatic duct dilation.

Publication History

Article published online:
14 April 2022