Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC 27834, USA.
Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC 27834, USA.
Int J Mol Sci. 2020 Feb 9;21(3):1147. doi: 10.3390/ijms21031147.
A significant proportion of patients with intraductal papillary mucinous neoplasms (IPMNs) undergo surgical resection in order to prevent or treat pancreatic cancer at the risk of significant perioperative morbidity. Efforts have been made to stratify the potential risk of malignancy based on the clinical and radiographic features of IPMN to delineate which cysts warrant resection versus observation. An analysis of the cyst fluid obtained by preoperative endoscopic examination appears to be correlative of cyst type and risk, whereas serum markers and radiographic findings have not yet reached a level of sensitivity or specificity that proves they are clinically meaningful. In this review, we investigate the current cyst fluid analysis studies and present those that have shown promise in effectively stratifying high-risk versus low-risk lesions. While new cyst fluid markers continue to be identified, additional efforts in testing panels and marker composites in conjunction with clinical algorithms have also shown promise in distinguishing dysplasia and the risk of malignancy. These should be tested prospectively in order to determine their role in guiding the surveillance of low-risk lesions and to evaluate the new markers detected by proteomics and genetic sequencing.
相当一部分的管内乳头状黏液性肿瘤（IPMN）患者为了预防或治疗胰腺癌而接受手术切除，因为这些患者存在显著的围手术期发病率风险。目前已经做出了一些努力，根据 IPMN 的临床和影像学特征对恶性潜能进行分层，以确定哪些囊肿需要切除，哪些需要观察。术前内镜检查获得的囊液分析似乎与囊肿类型和风险相关，而血清标志物和影像学发现尚未达到灵敏度或特异性的水平，证明它们具有临床意义。在这篇综述中，我们调查了目前的囊液分析研究，并介绍了那些在有效分层高危与低危病变方面有希望的研究。虽然新的囊液标志物仍在不断被发现，但联合临床算法对标志物组合进行测试的进一步研究也显示出了在鉴别发育不良和恶性风险方面的潜力。这些应该进行前瞻性测试，以确定它们在指导低危病变监测中的作用，并评估蛋白质组学和基因测序检测到的新标志物。
