Pancreatic cysts are incidentally detected in up to 13% of patients undergoing radiographic imaging. Of the most frequently encountered types, mucin-producing (mucinous) pancreatic cystic lesions may develop into pancreatic cancer, while non-mucinous ones have little or no malignant potential. Accurate preoperative diagnosis is critical for optimal management but has been difficult to achieve, resulting in unnecessary major surgery. Here, we aim to develop an Algorithm based upon biomarker risk scores to improve risk stratification.
Patients undergoing surgery and/or surveillance for a pancreatic cystic lesion with diagnostic imaging and banked pancreatic cyst fluid were enrolled in the study following informed consent (n=163 surgical, 67 surveillance). Cyst fluid biomarkers with high specificity for distinguishing non-mucinous from mucinous pancreatic cysts (vascular endothelial growth factor [VEGF], glucose, carcinoembryonic antigen [CEA], amylase, cytology, and DNA mutation) were selected. Biomarker risk scores were used to design an Algorithm to predict preoperative diagnosis. Performance was tested using surgical (retrospective) and surveillance (prospective) cohorts.
In the surgical cohort, the biomarker Algorithm outperformed the preoperative clinical diagnosis in correctly predicting the final pathological diagnosis (91% vs. 73%; P<0.000001). Specifically, non-mucinous serous cystic neoplasms (SCN) and mucinous cystic neoplasms (MCN) were more frequently correctly classified by the algorithm than clinical diagnosis (96% vs 30%; P1 follow-up visits.
A biomarker risk score-based Algorithm was able to correctly classify pancreatic cysts preoperatively. Importantly, this tool may improve initial and dynamic risk stratification, thus reducing overdiagnosis and underdiagnosis.

Copyright © 2021. Published by Elsevier Inc.