目前的护理成像标准,细胞学,或囊性液体分析不能可靠地区分恶性和良性胰腺囊性肿瘤。这项研究试图确定囊性液体的代谢特征是否可以区分良性和恶性病变。以及粘液性和非粘液性病变。
通过非靶向质谱和定量核磁共振对24例手术切除的胰腺囊肿液进行代谢分析,并与病理诊断和临床病理相关。
(Iso)-丁酰肉碱区分恶性和良性胰腺囊肿,诊断准确率为89%。(Iso)-丁酰肉碱在恶性囊肿液中的含量是良性囊肿液中的28倍(P=.048)。此外,5-氧代脯氨酸(P=0.01)将粘液性与非粘液性囊肿区分开来,诊断准确率为90%,优于葡萄糖(82%的准确性),一种先前描述的代谢产物,可区分粘液性和非粘液性囊肿。葡萄糖和5-氧代脯氨酸的联合分析并不能提高诊断准确性。相比之下,护理标准囊肿液癌胚抗原(CEA)和细胞学检查对粘液性囊肿的诊断准确率分别为40%和60%。(Iso)-丁酰肉碱和5-氧代脯氨酸与囊肿液CEA水平相关(分别为P<.0001和P<.05)。为了诊断恶性胰腺囊肿,囊肿大小>3厘米的诊断准确性,≥1个高风险特征,囊肿液CEA,细胞学占38%,75%,80%,75%,分别。
(Iso)-丁酰肉碱在准确区分恶性和良性胰腺囊肿方面具有潜在的临床应用价值。和5-氧代脯氨酸用于区分粘液性和非粘液性囊肿。
Current standard of care imaging, cytology, or cystic fluid analysis cannot reliably differentiate malignant from benign pancreatic cystic neoplasms. This study sought to determine if the metabolic profile of cystic fluid could distinguish benign and malignant lesions, as well as mucinous and non-mucinous lesions.
Metabolic profiling by untargeted mass spectrometry and quantitative nuclear magnetic resonance was performed in 24 pancreatic cyst fluid from surgically resected samples with pathological diagnoses and clinicopathological correlation.
(Iso)-
butyrylcarnitine distinguished malignant from benign pancreatic cysts, with a diagnostic accuracy of 89%. (Iso)-
butyrylcarnitine was 28-fold more abundant in malignant cyst fluid compared with benign cyst fluid (P=.048). Furthermore, 5-oxoproline (P=.01) differentiated mucinous from non-mucinous cysts with a diagnostic accuracy of 90%, better than glucose (82% accuracy), a previously described metabolite that distinguishes mucinous from non-mucinous cysts. Combined analysis of glucose and 5-oxoproline did not improve the diagnostic accuracy. In comparison, standard of care cyst fluid carcinoembryonic antigen (CEA) and cytology had a diagnostic accuracy of 40% and 60% respectively for mucinous cysts. (Iso)-
butyrylcarnitine and 5-oxoproline correlated with cyst fluid CEA levels (P<.0001 and P<.05 respectively). For diagnosing malignant pancreatic cysts, the diagnostic accuracies of cyst size > 3 cm, ≥ 1 high-risk features, cyst fluid CEA, and cytology are 38%, 75%, 80%, and 75%, respectively.
(Iso)-
butyrylcarnitine has potential clinical application for accurately distinguishing malignant from benign pancreatic cysts, and 5-oxoproline for distinguishing mucinous from non-mucinous cysts.