Cyst Fluid Glucose is Rapidly Feasible and Accurate in Diagnosing Mucinous Pancreatic Cysts

• Published in: The American journal of gastroenterology Vol. 110; no. 6; pp. 909 - 914
• Main Authors: Zikos, Thomas, Pham, Kimberly, Bowen, Raffick, Chen, Ann M, Banerjee, Subhas, Friedland, Shai, Dua, Monica M, Norton, Jeffrey A, Poultsides, George A, Visser, Brendan C, Park, Walter G
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01-06-2015
• Subjects: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor - analysis; Biomarkers, Tumor - metabolism; Biopsy, Fine-Needle; Carcinoembryonic Antigen - analysis; Carcinoembryonic Antigen - metabolism; Carcinoma, Pancreatic Ductal - diagnosis; Carcinoma, Pancreatic Ductal - metabolism; Cyst Fluid - chemistry; Cystadenocarcinoma - diagnosis; Cystadenocarcinoma - metabolism; Cystadenocarcinoma, Mucinous - diagnosis; Cystadenocarcinoma, Mucinous - metabolism; Female; Gastroenterology; Glucose - analysis; Glucose - metabolism; Humans; Male; Middle Aged; Neoplasms, Cystic, Mucinous, and Serous - diagnosis; Neoplasms, Cystic, Mucinous, and Serous - metabolism; Pancreatic Cyst - diagnosis; Pancreatic Cyst - metabolism; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - metabolism; Pancreatic Pseudocyst - diagnosis; Pancreatic Pseudocyst - metabolism; Prospective Studies; Sensitivity and Specificity; Young Adult
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1038/ajg.2015.148

Better diagnostic tools are needed to differentiate pancreatic cyst subtypes. A previous metabolomic study showed cyst fluid glucose as a potential marker to differentiate mucinous from non-mucinous pancreatic cysts. This study seeks to validate these earlier findings using a standard laboratory glucose assay, a glucometer, and a glucose reagent strip.
Using an IRB-approved prospectively collected bio-repository, 65 pancreatic cyst fluid samples (42 mucinous and 23 non-mucinous) with histological correlation were analyzed.
Median laboratory glucose, glucometer glucose, and percent reagent strip positive were lower in mucinous vs. non-mucinous cysts (P<0.0001 for all comparisons). Laboratory glucose<50 mg/dl had a sensitivity of 95% and a specificity of 57% (LR+ 2.19, LR- 0.08). Glucometer glucose<50 mg/dl had a sensitivity of 88% and a specificity of 78% (LR+ 4.05, LR- 0.15). Reagent strip glucose had a sensitivity of 81% and a specificity of 74% (LR+ 3.10, LR- 0.26). CEA had a sensitivity of 77% and a specificity of 83% (LR+ 4.67, LR- 0.27). The combination of having either a glucometer glucose<50 mg/dl or a CEA level>192 had a sensitivity of 100% but a low specificity of 33% (LR+ 1.50, LR- 0.00).
Glucose, whether measured by a laboratory assay, a glucometer, or a reagent strip, is significantly lower in mucinous cysts compared with non-mucinous pancreatic cysts.