Department of Hepatology and Endemic Medicine, Cairo University, Cairo, Egypt.
Department of Clinical Pathology, Cairo University, Cairo, Egypt.
Saudi J Gastroenterol. 2022 Sep-Oct;28(5):348-354. doi: 10.4103/sjg.sjg_81_22.
Diagnosis of malignant pancreatic cystic lesions (PCLs) is challenging as there is no investigation that offers both high diagnostic sensitivity and specificity for a definite diagnosis. Accurate diagnosis of cyst type is vital in order to not miss opportunities for early treatment of potentially malignant lesions and to avoid unnecessary surgeries. Serine protease inhibitor Kazal type I (SPINK1) and glucose are promising cyst fluid markers for differentiation of mucinous from non-mucinous cysts. We aim to validate the value of SPINK1 and glucose in detecting potentially malignant PCLs.
A prospective study was conducted on 80 patients presenting with PCLs. Endoscopic ultrasound (EUS) evaluation of detailed cyst morphology and EUS with fine needle aspiration (FNA) were done. Fluid analysis for carcinoembryonic antigen (CEA), glucose and SPINK1 and cytopathology were done. We compared these data with the final diagnosis based on cytopathological and postoperative histopathological examination.
Cyst fluid SPINK1 was significantly higher in malignant or potentially malignant cysts compared to benign cysts (0.91 vs 0.47 ng/ml; P = 0.001). Also, glucose was significantly lower in malignant or potentially malignant cysts compared to benign cysts (21.5 vs 68.5 mg/dl; P = 0.0001). Glucose and SPINK1 had the best sensitivity and specificity for differentiating mucinous from non-mucinous cysts with 84.78% and 73.53% (AUC 0.76; 95% CI [0.65-0.88]; cutoff value = 42 mg/dl), and 70.59% and 65.22% (AUC 0.72; 95% CI [0.64-0.86]; cutoff value = 0.58 ug/L) respectively. CEA level >192 ng/ml, high SPINK1 level and lymph node enlargement were the independent predictors of malignant cysts.
Cyst fluid SPINK1 and glucose are promising diagnostic markers for the diagnosis of potentially malignant PCLs.
恶性胰腺囊性病变（PCL）的诊断具有挑战性，因为目前尚无一种检查方法能同时提供高诊断灵敏度和特异性，以明确诊断。准确诊断囊型对于不失良机地治疗潜在恶性病变以及避免不必要的手术至关重要。丝氨酸蛋白酶抑制剂 Kazal 型 1（SPINK1）和葡萄糖是鉴别黏液性和非黏液性囊肿的有前途的囊液标志物。我们旨在验证 SPINK1 和葡萄糖在检测潜在恶性 PCL 中的价值。
对 80 例 PCL 患者进行前瞻性研究。进行内镜超声（EUS）评估详细的囊肿形态和 EUS 细针抽吸（FNA）。进行囊液癌胚抗原（CEA）、葡萄糖和 SPINK1 以及细胞学分析。我们将这些数据与基于细胞病理学和术后组织病理学检查的最终诊断进行比较。
与良性囊肿相比，恶性或潜在恶性囊肿的囊液 SPINK1 明显更高（0.91 与 0.47 ng/ml；P = 0.001）。此外，恶性或潜在恶性囊肿的葡萄糖明显低于良性囊肿（21.5 与 68.5 mg/dl；P = 0.0001）。葡萄糖和 SPINK1 对鉴别黏液性和非黏液性囊肿具有最佳的灵敏度和特异性，分别为 84.78%和 73.53%（AUC 0.76；95%CI [0.65-0.88]；临界值=42 mg/dl）和 70.59%和 65.22%（AUC 0.72；95%CI [0.64-0.86]；临界值=0.58 ug/L）。CEA 水平>192 ng/ml、高 SPINK1 水平和淋巴结肿大是恶性囊肿的独立预测因子。
囊液 SPINK1 和葡萄糖是诊断潜在恶性 PCL 的有前途的诊断标志物。
