Browsing by Subject "pancreatic cyst"

Now showing 1 - 4 of 4
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    Circulating Thrombospondin-2 enhances prediction of malignant intraductal papillary mucinous neoplasm
    (Elsevier, 2018) Simpson, Rachel E.; Yip-Schneider, Michele T.; Wu, Huangbing; Fan, Hao; Liu, Ziyue; Korc, Murray; Zhang, Jianjun; Schmidt, C. Max; Surgery, School of Medicine
    Background IPMNs are cystic pancreatic lesions with variable malignant potential. Thrombospondin-2 (THBS2)—an endogenous, anti-angiogenic matrix glycoprotein—may modulate tumor progression. We hypothesized that circulating levels of THBS2 could aid in preoperative prediction of malignant IPMN. Methods Preoperative serum/plasma samples were procured from patients undergoing surgery. Circulating levels of THBS2 were measured (enzyme-linked immunosorbent assay) and compared to surgical pathology IPMN dysplastic grade. Results 164 patients underwent THBS2 testing (100 Low/Moderate-IPMN; 64 High-Grade/Invasive-IPMN). Circulating THBS2 (mean ± SD) was greater in High-Grade/Invasive-IPMN than Low/Moderate-grade IPMN (26.6 ± 12.7 ng/mL vs. 20.4 ± 8.2 ng/mL; P < 0.001). THBS2 (AUC = 0.65) out-performed CA19-9 (n = 144; AUC = 0.59) in predicting IPMN grade. The combination of THBS2, CA19-9, radiographic main-duct involvement, main-duct diameter, age, sex, and BMI (AUC 0.82; n = 137) provided a good prediction model for IPMN grade. Conclusion Circulating THBS2 is correlated with IPMN dysplasia grade. THBS2 alone did not strongly predict IPMN grade but rather strengthened prediction models for High-Grade/Invasive IPMN when combined with other clinical/biomarker data.
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    Pancreatic Fluid Interleukin-1β Complements Prostaglandin E2 and Serum Carbohydrate Antigen 19-9 in Prediction of Intraductal Papillary Mucinous Neoplasm Dysplasia
    (Wolters Kluwer, 2019-09-01) Simpson, Rachel E.; Yip-Schneider, Michele T.; Flick, Katelyn F.; Wu, Huangbing; Colgate, Cameron L.; Schmidt, C. Max; Surgery, School of Medicine
    Objectives: We sought to determine if interleukin (IL)-1β and prostaglandin E2 (PGE2) (inflammatory mediators in pancreatic fluid) together with serum carbohydrate antigen (CA) 19–9 could better predict intraductal papillary mucinous neoplasm (IPMN) dysplasia than individual biomarkers alone. Methods: Pancreatic cyst fluid (n = 92) collected via endoscopy or surgery (2003–2016) was analyzed for PGE2 and IL-1β (Enzyme-Linked Immunosorbent Assay). Patients had surgical pathology-proven IPMN. Threshold values (PGE2 [>1100 pg/mL], IL-1β [>20 pg/mL], serum CA 19–9 [>36 U/mL]) were determined. Results: Levels of IL-1β were higher in high-grade (HGD)/Invasive-IPMN (n = 42) compared to Low/Moderate-IPMN (n = 37) (median [range], 54.6 [0–2671] vs 5.9 [0–797] pg/mL; P < 0.001; Area Under Curve [AUC], 0.766). Similarly, PGE2 was higher in HGD/Invasive-IPMN (n = 45) compared to Low/Moderate-IPMN (n = 47) (median [range], 1790 [20–15,180] vs. 140 [10–14,630] pg/mL; P < 0.001; AUC, 0.748). Presence of elevated PGE2 and IL-1β (AUC, 0.789) provided 89% specificity and 82% positive predictive value (PPV) for HGD/Invasive-IPMN. Elevated levels of all three provided 100% Specificity and PPV for HGD/Invasive-IPMN. Conclusion: Cyst fluid PGE2, IL-1β, and serum CA 19–9 in combination optimize specificity and PPV for HGD/Invasive-IPMN and may help build a panel of markers to predict IPMN dysplasia.
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    Performance of Candidate Urinary Biomarkers for Pancreatic Cancer - Correlation with Pancreatic Cyst Malignant Progression?
    (Elsevier, 2019) Yip-Schneider, Michele T.; Soufi, Mazhar; Carr, Rosalie A.; Flick, Katelyn F.; Wu, Huangbing; Colgate, Cameron L.; Schmidt, C. Max; Surgery, School of Medicine
    Background Intraductal papillary mucinous neoplasms (IPMN) are precursors of pancreatic cancer. Potential biomarkers of IPMN progression have not been identified in urine. A few urinary biomarkers were reported to be predictive of pancreatic ductal adenocarcinoma (PDAC). Here, we seek to assess their ability to detect high-risk IPMN. Methods Urine was collected from patients undergoing pancreatic resection and healthy controls. TIMP-1(Tissue Inhibitor of Metalloproteinase-1), LYVE-1(Lymphatic Vessel Endothelial Receptor 1), and PGEM(Prostaglandin E Metabolite) levels were determined by ELISA and analyzed by Kruskal-Wallis. Results Median urinary TIMP-1 levels were significantly lower in healthy controls (n = 9; 0.32 ng/mg creatinine) compared to PDAC (n = 13; 1.95) but not significantly different between low/moderate-grade (n = 20; 0.71) and high-grade/invasive IPMN (n = 20; 1.12). No significant difference in urinary LYVE-1 was detected between IPMN low/moderate (n = 16; 0.37 ng/mg creatinine) and high/invasive grades (n = 21; 0.09). Urinary PGEM levels were not significantly different between groups. Conclusions Urinary TIMP-1, LYVE-1, and PGEM do not correlate with malignant potential of pancreatic cysts.
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    Secretin-induced Duodenal Aspirate of Pancreatic Juice (SIDA): Utility of Commercial Genetic Analysis
    (International Institute of Anticancer Research, 2020) Simpson, Rachel E.; Yip-Schneider, Michele; Flick, Katelyn F.; Soufi, Mazhar; Ceppa, Eugene P.; Al-Haddad, Mohammad A.; Easler, Jeffrey J.; Sherman, Stuart; Dewitt, John M.; Schmidt, C. Max; Surgery, School of Medicine
    Background: Secretin-induced duodenal aspiration (SIDA) of pancreatic duct fluid has been proposed for pancreatic neoplasm screening in very high-risk patients. We sought to determine the clinical yield and safety of commercially-analyzed SIDA samples in patients at moderately elevated risk. Patients and Methods: A prospectively maintained institutional database of pancreatic fluid DNA profiles was retrospectively reviewed. Results: Fifty-seven patients underwent SIDA testing, most commonly for intraductal papillary mucinous neoplasms (n=43) and not otherwise specified solitary cysts (n=9). SIDA mutation yield was low compared to 37 concomitant endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) samples of pancreatic fluid: KRAS (2.5% vs. 40.0%), GNAS (2.6% vs. 11.1%) and allelic loss of heterozygosity (3.1% vs. 0%). Patients undergoing SIDA alone experienced no complications while 3 patients with concomitant EUS-FNA had post-procedural pancreatitis. Conclusion: The genetic yield of commercially-analyzed SIDA samples was relatively low in a moderately elevated risk cohort. SIDA testing may have a better safety profile than EUS-FNA.