Department of Internal Medicine, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Int J Mol Sci. 2021 Nov 27;22(23):12839. doi: 10.3390/ijms222312839.
Pancreatic cystic lesions are increasingly detected in cross-sectional imaging. Intraductal papillary mucinous neoplasm (IPMN) is a mucin-producing subtype of the pancreatic cyst lesions arising from the pancreatic duct system. IPMN is a potential precursor of pancreatic cancer. The transformation of IPMN in pancreatic cancer is progressive and requires the occurrence of low-grade dysplasia, high-grade dysplasia, and ultimately invasive cancer. Jaundice, enhancing mural nodule >5 mm, main pancreatic duct diameter >10 mm, and positive cytology for high-grade dysplasia are considered high-risk stigmata of malignancy. While increased levels of carbohydrate antigen 19-9 (CA 19-9) (>37 U/mL), main pancreatic duct diameter 5-9.9 mm, cyst diameter >40 mm, enhancing mural nodules <5 mm, IPMN-induced acute pancreatitis, new onset of diabetes, cyst grow-rate >5 mm/year are considered worrisome features of malignancy. However, cross-sectional imaging is often inadequate in the prediction of high-grade dysplasia and invasive cancer. Several studies evaluated the role of humoral and intra-cystic biomarkers in the prediction of malignancy in IPMN. Carcinoembryonic antigen (CEA), CA 19-9, intra-cystic CEA, intra-cystic glucose, and cystic fluid cytology are widely used in clinical practice to distinguish between mucinous and non-mucinous cysts and to predict the presence of invasive cancer. Other biomarkers such as cystic fluid DNA sequencing, microRNA (mi-RNA), circulating microvesicles, and liquid biopsy are the new options for the mini-invasive diagnosis of degenerated IPMN. The aim of this study is to review the literature to assess the role of humoral and intracystic biomarkers in the prediction of advanced IPMN with high-grade dysplasia or invasive carcinoma.
胰腺囊性病变在影像学检查中越来越常见。导管内乳头状黏液性肿瘤（IPMN）是一种来源于胰管系统的黏液性胰腺囊性病变，是胰腺癌的潜在前体病变。IPMN 向胰腺癌的转化是渐进的，需要发生低级别异型增生、高级别异型增生，最终发展为浸润性癌。黄疸、增强壁结节>5mm、主胰管直径>10mm、高级别异型增生的细胞学阳性被认为是恶性的高危特征。而糖类抗原 19-9（CA 19-9）水平升高（>37U/mL）、主胰管直径 5-9.9mm、囊肿直径>40mm、增强壁结节<5mm、IPMN 引起的急性胰腺炎、新发糖尿病、囊肿生长速度>5mm/年被认为是恶性的可疑特征。然而，影像学检查在预测高级别异型增生和浸润性癌方面往往不足。一些研究评估了体液和囊内生物标志物在预测 IPMN 恶性肿瘤中的作用。癌胚抗原（CEA）、CA 19-9、囊内 CEA、囊内葡萄糖和囊液细胞学广泛用于临床实践，以区分黏液性和非黏液性囊肿，并预测浸润性癌的存在。其他生物标志物，如囊液 DNA 测序、微小 RNA（miRNA）、循环微泡和液体活检，是退行性 IPMN 微创诊断的新选择。本研究旨在综述文献，评估体液和囊内标志物在预测高级别异型增生或浸润性癌的 IPMN 中的作用。
