Pancreatic Cyst Fluid Vascular Endothelial Growth Factor A and Carcinoembryonic Antigen: A Highly Accurate Test for the Diagnosis of Serous Cystic Neoplasm
Pancreatic Cyst Fluid Vascular Endothelial Growth Factor A and Carcinoembryonic Antigen: A Highly Accurate Test for the Diagnosis of Serous Cystic Neoplasm
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DOI：
10.1016/j.jamcollsurg.2017.05.003
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发表时间：
2017-07-01
影响因子：
5.2
通讯作者：
Schmidt, C. Max
中科院分区：
文献类型：
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作者：
Carr, Rosalie A.;Yip-Schneider, Michele T.;Schmidt, C. Max
背景：准确区分胰腺囊性病变对于胰腺癌的早期发现和预防以及避免不必要的手术干预具有重要意义。浆液性囊性肿瘤（SCN）没有恶性潜力，但可以模仿以下癌前粘液性囊性病变：粘液性囊性肿瘤和导管内乳头状粘液性肿瘤（IPMN）。我们最近发现血管内皮生长因子 (VEGF)-A 是一种新型胰液 SCN 生物标志物。我们假设囊液CEA与VEGF-A相结合将提高VEGF-A的诊断准确性。方法：从同意进行囊肿切除术并有相应病理诊断的患者中收集胰腺囊肿/导管液。采用ELISA法检测胰液VEGF-A、CEA水平。结果：149例胰腺囊性病变患者符合纳入标准。病理诊断包括假性囊肿（n = 14）、SCN（n = 26）、粘液性囊性肿瘤（n = 40）、低/中度IPMN（n = 34）、高级别IPMN（n = 20）、侵袭性IPMN（n = 10）和实性假乳头状肿瘤（n = 5）。与所有其他诊断相比，SCN 囊肿液中的血管内皮生长因子 A 显着升高 (p < 0.001)。 VEGF-A 的阈值 > 5,000 pg/mL，单独使用 VEGF-A 即可将 SCN 与其他囊性病变区分开来，其敏感性为 100%，特异性为 83.7%。阈值为
BACKGROUND: Accurate differentiation of pancreatic cystic lesions is important for early detection and prevention of pancreatic cancer, as well as avoidance of unnecessary surgical intervention. Serous cystic neoplasms (SCNs) have no malignant potential, but can mimic the following premalignant mucinous cystic lesions: mucinous cystic neoplasm and intraductal papillary mucinous neoplasm (IPMN). We recently identified vascular endothelial growth factor (VEGF)-A as a novel pancreatic fluid biomarker for SCN. We hypothesize that combining cyst fluid CEA with VEGF-A will improve the diagnostic accuracy of VEGF-A.METHODS: Pancreatic cyst/duct fluid was collected from consenting patients undergoing surgical cyst resection with corresponding pathologic diagnoses. Pancreatic fluid VEGF-A and CEA levels were detected by ELISA.RESULTS: One hundred and forty-nine patients with pancreatic cystic lesions met inclusion criteria. Pathologic diagnoses included pseudocyst (n = 14), SCN (n = 26), mucinous cystic neoplasm (n = 40), low-/moderate-grade IPMN (n = 34), high-grade IPMN (n = 20), invasive IPMN (n = 10), and solid pseudopapillary neoplasm (n = 5). Vascular endothelial growth factor A was significantly elevated in SCN cyst fluid compared with all other diagnoses (p < 0.001). With a threshold of > 5,000 pg/mL, VEGF-A alone has 100% sensitivity and 83.7% specificity to distinguish SCNs from other cystic lesions. With a threshold of