Metabolomic-derived novel cyst fluid biomarkers for pancreatic cysts: Glucose and kynurenine

Walter G. Park, Manhong Wu, Raffick Bowen, Ming Zheng, William L. Fitch, Reetesh K. Pai, Dariusz Wodziak, Brendan C. Visser, George A. Poultsides, Jeff A. Norton, Subhas Banerjee, Ann M. Chen, Shai Friedland, Brennan A. Scott, Pankaj Jay Pasricha, Anson W. Lowe, Gary Peltz

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Better pancreatic cyst fluid biomarkers are needed. Objective: To determine whether metabolomic profiling of pancreatic cyst fluid would yield clinically useful cyst fluid biomarkers. Design: Retrospective study. Setting: Tertiary-care referral center. Patients: Two independent cohorts of patients (n = 26 and n = 19) with histologically defined pancreatic cysts. Intervention: Exploratory analysis for differentially expressed metabolites between (1) nonmucinous and mucinous cysts and (2) malignant and premalignant cysts was performed in the first cohort. With the second cohort, a validation analysis of promising identified metabolites was performed. Main Outcome Measurements: Identification of differentially expressed metabolites between clinically relevant cyst categories and their diagnostic performance (receiver operating characteristic [ROC] curve). Results: Two metabolites had diagnostic significance - glucose and kynurenine. Metabolomic abundances for both were significantly lower in mucinous cysts compared with nonmucinous cysts in both cohorts (glucose first cohort P =.002, validation P =.006; and kynurenine first cohort P =.002, validation P =.002). The ROC curve for glucose was 0.92 (95% confidence interval [CI], 0.81-1.00) and 0.88 (95% CI, 0.72-1.00) in the first and validation cohorts, respectively. The ROC for kynurenine was 0.94 (95% CI, 0.81-1.00) and 0.92 (95% CI, 0.76-1.00) in the first and validation cohorts, respectively. Neither could differentiate premalignant from malignant cysts. Glucose and kynurenine levels were significantly elevated for serous cystadenomas in both cohorts. Limitations: Small sample sizes. Conclusion: Metabolomic profiling identified glucose and kynurenine to have potential clinical utility for differentiating mucinous from nonmucinous pancreatic cysts. These markers also may diagnose serous cystadenomas.

Original languageEnglish (US)
Pages (from-to)295-302.e2
JournalGastrointestinal endoscopy
Volume78
Issue number2
DOIs
StatePublished - Aug 2013
Externally publishedYes

Keywords

  • CEA
  • CI
  • IPMN
  • IQR
  • LC/MS
  • MCN
  • MS
  • ROC
  • SCA
  • carcinoembryonic antigen
  • confidence interval
  • interquartile range
  • intraductal papillary mucinous neoplasm
  • liquid chromatography with mass spectrometry
  • mass spectrometry
  • mucinous cystic neoplasm
  • receiver operating characteristic
  • serous cystadenoma

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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