Stratifying Intraductal Papillary Mucinous Neoplasms by Cyst Fluid Analysis: Present and Future
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Date
2020-02-09
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Authors
Hao, Scarlett
Takahashi, Caitlin
Snyder, Rebecca A.
Parikh, Alexander A.
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Abstract
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.
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DOI
10.3390/ijms21031147