PGE 2 in pancreatic cyst fluid helps differentiate IPMN from MCN and predict IPMN Dysplasia

C. Schmidt, Michele Yip-Schneider, Matthew C. Ralstin, Sabrina Wentz, John DeWitt, Stuart Sherman, Thomas Howard, Lee McHenry, Sarah Dutkevitch, Michael Goggins, Attila Nakeeb, Keith D. Lillemoe

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Current management of intraductal papillary mucinous neoplasm (IPMN) according to recently published International Consensus Guidelines depends upon distinguishing it from mucinous cystic neoplasms (MCNs). We have previously shown that prostaglandin E 2 (PGE 2) is increased in pancreatic cancer tissue over normal controls. Thus, we hypothesized that PGE 2 level in pancreatic fluid differentiates IPMN and MCN and is a biomarker of IPMN dysplasia. Pancreatic fluid was collected in 65 patients at the time of endoscopy (EUS or ERCP) or operation (OR) and analyzed by PGE 2 enzyme-linked immunosorbent assay (ELISA). PGE 2 level was correlated with surgical pathologic diagnosis and dysplastic stage. Mean PGE 2 level (pg/μl) in IPMNs (2.2±0.6) was greater than in MCNs (0.2±0.1) (p<0.05). Mean PGE 2 level of IPMN by dysplastic stage was 0.1±0.01 (low grade), 1.2±0.6 (medium grade), 4.4±0.9 (high grade), and 5.0±2.3 (invasive). Among invasive IPMN, PGE 2 level dropped in advanced cases with pancreatic ductal obstruction by tumor (0.3±0) vs non-obstructed (8.6±2.9). PGE 2 level may help in distinguishing IPMN from MCN in patients with known mucinous lesions. PGE 2 level may also be an indicator of malignant progression of IPMN before ductal obstruction by tumor. Prospective evaluation will be necessary to evaluate the clinical role of PGE 2 level in pancreatic fluid.

Original languageEnglish
Pages (from-to)243-249
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume12
Issue number2
DOIs
StatePublished - 2008

Fingerprint

Pancreatic Cyst
Cyst Fluid
Prostaglandins E
Neoplasms
Endoscopic Retrograde Cholangiopancreatography
Pancreatic Neoplasms

Keywords

  • Biomarker
  • Dysplasia
  • Intraductal papillary mucinous neoplasm
  • Mucinous cystic neoplasm
  • Pancreatic adenocarcinoma
  • Pancreatic cancer
  • PGE2
  • Prostaglandin E2

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

PGE 2 in pancreatic cyst fluid helps differentiate IPMN from MCN and predict IPMN Dysplasia. / Schmidt, C.; Yip-Schneider, Michele; Ralstin, Matthew C.; Wentz, Sabrina; DeWitt, John; Sherman, Stuart; Howard, Thomas; McHenry, Lee; Dutkevitch, Sarah; Goggins, Michael; Nakeeb, Attila; Lillemoe, Keith D.

In: Journal of Gastrointestinal Surgery, Vol. 12, No. 2, 2008, p. 243-249.

Research output: Contribution to journalArticle

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abstract = "Current management of intraductal papillary mucinous neoplasm (IPMN) according to recently published International Consensus Guidelines depends upon distinguishing it from mucinous cystic neoplasms (MCNs). We have previously shown that prostaglandin E 2 (PGE 2) is increased in pancreatic cancer tissue over normal controls. Thus, we hypothesized that PGE 2 level in pancreatic fluid differentiates IPMN and MCN and is a biomarker of IPMN dysplasia. Pancreatic fluid was collected in 65 patients at the time of endoscopy (EUS or ERCP) or operation (OR) and analyzed by PGE 2 enzyme-linked immunosorbent assay (ELISA). PGE 2 level was correlated with surgical pathologic diagnosis and dysplastic stage. Mean PGE 2 level (pg/μl) in IPMNs (2.2±0.6) was greater than in MCNs (0.2±0.1) (p<0.05). Mean PGE 2 level of IPMN by dysplastic stage was 0.1±0.01 (low grade), 1.2±0.6 (medium grade), 4.4±0.9 (high grade), and 5.0±2.3 (invasive). Among invasive IPMN, PGE 2 level dropped in advanced cases with pancreatic ductal obstruction by tumor (0.3±0) vs non-obstructed (8.6±2.9). PGE 2 level may help in distinguishing IPMN from MCN in patients with known mucinous lesions. PGE 2 level may also be an indicator of malignant progression of IPMN before ductal obstruction by tumor. Prospective evaluation will be necessary to evaluate the clinical role of PGE 2 level in pancreatic fluid.",
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AU - Dutkevitch, Sarah

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AU - Nakeeb, Attila

AU - Lillemoe, Keith D.

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