Identification of Malignant Pancreatic Cysts May Lower Cancer Risk

A new study has identified candidate biomarkers for the diagnosis of pancreatic cystic neoplasms, helping clinicians predict whether the cysts are benign or are precursors to invasive cancer.

Researchers at the University of Michigan (Ann Arbor, USA), Indiana University (Purdue, USA), and the Van Andel Research Institute (VARI, Grand Rapids, MI, USA) used a novel antibody-lectin sandwich microarray method to measure the protein expression and glycosylation of mucin (MUC)1, MUC5AC, MUC16, carcinoembryonic antigen, and other proteins implicated in pancreatic neoplasia in cyst fluid samples. A total of 53 cyst fluid samples were obtained from patients with mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, serous cystadenomas, or pseudocysts, with confirmation of histologic diagnosis at surgical resection.

The results showed that the detection of a glycan variant on MUC5AC discriminated mucin-producing cystic tumors (mucinous cystic neoplasms and intraductal papillary mucinous neoplasms) from benign cystic lesions (serous cystadenomas and pseudocysts) with 78% sensitivity at 80% specificity; when used in combination with cyst fluid CA 19-9, the results were even higher, with a sensitivity of 87% at 86% specificity. The researchers also reported that the biomarkers performed better than cyst fluid carcinoembryonic antigen. The study was published in the May 2010 issue of Annals of Surgery.

"Because of the difficulty in detecting pancreatic cancer in its early stages, most cancers are advanced at the time of diagnosis and recur after removal of the tumor,” said lead author Brian Haab, Ph.D., a senior scientific investigator at VARI. "These results demonstrate the value of glycan variants for biomarker discovery and suggest that these biomarkers could greatly enhance the accuracy of differentiating pancreatic cystic tumors.”

The most common and deadly form of pancreatic cancer, pancreatic ductal adenocarcinomas, develops from three types of cysts. Moreover, although the most prevalent type is too small to be detected visually, cystic lesions of the pancreas are increasingly being recognized due to widespread use of high-resolution abdominal imaging. This situation presents an opportunity to intervene prior to malignant progression; however, effective implementation of this strategy has so far been hampered by difficulties in clearly distinguishing between cystic lesions with no malignant potential and those with malignant potential.

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University of Michigan
Indiana University
Van Andel Research Institute