The utility of intracystic glucose levels in differentiating mucinous from non-mucinous pancreatic cysts.

Background: Differentiating benign non-mucinous from potentially malignant mucinous pancreatic cysts is still a challenge. This study aims to improve this distinction with cyst fluid analysis.
Methods: A cohort study of pancreatic cyst undergoing EUS/FNA was performed from a prospectively maintained database between 2014 and 2018 was performed.
Results: 113 patients were analyzed (40 non-mucinous and 73 mucinous). For differentiating mucinous from non-mucinous cyst: intracyst glucose ≤41 mg/dl had a sensitivity of 92% and a specificity of 92%; positive predictive value (PPV) of 96 and negative predictive value (NPV) of 86. Glucose ≤21 mg/dl had a sensitivity of 88%, specificity of 97%, PPV of 98 and NPV of 81. CEA ≥192 ng/mL had a sensitivity of 50% and a specificity of 92%; PPV of 92 and NPV of 50. Glucose ≤21 mg/dl or CEA ≥192 ng/mL combined had a sensitivity of 93%, specificity of 92%, PPV of 96 and NPV of 87 (Fig. 1, Table 1).
Conclusion: Intra-cyst glucose levels (≤41 mg/dl) outperforms classic CEA testing for differentiation of mucinous from non-mucinous pancreatic cysts. It was found to be an excellent diagnostic test with an AUC of 0.95 (95% CI: 0.81, 0.97).
Competing Interests: Declaration of competing interest C. Roberto Simons-Linares MD MSc, Divya Yadav, Rocio Lopez, Amit Bhatt MD, Sunguk Jang MD, Faris El-Khider, Madhusudan Sanaka MD, Tyler Stevens MD, John Vargo MD MPH, Prabhleen Chahal MD have no conflicts of interest to disclose.
(Copyright © 2020 IAP and EPC. Published by Elsevier B.V. All rights reserved.)