Improving The Detection and Quantitation of Protein Expression Changes in Mucinous and Serous Pancreatic Cystic Neoplasms.

摘要

Pancreatic cysts account for over 30percent of pancreatic resections. Current preoperative differentiation of premalignant and malignant pancreatic cysts (mucinous) from benign pancreatic cysts (serous cystadenoma) based on imaging, cyst fluid cytology and cyst fluid tumor markers (e.g. CEA) is inadequate. This inability to accurately differentiate has led to the practice of resecting all. When no distinct mass is present, there is no reliable radiologic way to differentiate benign and premalignant from malignant cysts. The sensitivity of cyst fluid cytologic analysis is suboptimal due to the acellular nature of the specimen. (Brugge, Lewandrowski et al. 2004) Although pancreatic cyst fluid CEA level has been considered the most reliable predictor of the mucinous nature of a pancreatic cyst, it cannot predict the presence or absence of cancer. Better tools are needed to assess the presence or absence of malignancy, especially in patients who are deemed not optimal operative candidates. Better markers are required to predict the natural history of pancreatic cysts initially diagnosed as non-malignant. This study employs both uni and multi-dimensional liquid chromatographic separations and mass spectrometry to identify proteins or protein patterns in pancreatic cyst fluid which may more accurately predict pancreatic cyst pathology preoperatively and help triage patient care.