title: PGE(2) in pancreatic cyst fluid helps differentiate IPMN from MCN and predict IPMN dysplasia.
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/microl) 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.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. maxschmi@iupui.edu
authors.forename: C Max
authors.initials: CM
authors.lastname: Schmidt
authors.forename: Michele T
authors.initials: MT
authors.lastname: Yip-Schneider
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Ralstin
authors.forename: Sabrina
authors.initials: S
authors.lastname: Wentz
authors.forename: John
authors.initials: J
authors.lastname: DeWitt
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Howard
authors.forename: Lee
authors.initials: L
authors.lastname: McHenry
authors.forename: Sarah
authors.initials: S
authors.lastname: Dutkevitch
authors.forename: Michael
authors.initials: M
authors.lastname: Goggins
authors.forename: Attila
authors.initials: A
authors.lastname: Nakeeb
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000378:metabolism; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000378:metabolism* / Q000473:pathology; D002291:Carcinoma, Papillary / Q000175:diagnosis* / Q000378:metabolism* / Q000473:pathology; D003937:Diagnosis, Differential; D015232:Dinoprostone / Q000378:metabolism*; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D010181:Pancreatic Cyst / Q000378:metabolism*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000378:metabolism*
chemical_list: D015232:Dinoprostone