Inflammatory protein profiling of pancreatic cyst fluid using EUS-FNA in tandem with cytokine microarray differentiates between branch duct IPMN and inflammatory cysts.
BACKGROUND
Diagnosis of pancreatic cystic neoplasms remains problematic. We hypothesize that inflammatory mediator proteins in pancreatic cyst fluid can differentiate branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) and pancreatic inflammatory cysts. We aim to 1) detect inflammatory mediator proteins (IMPs) using a multiplexed IMP-targeted microarray in pancreatic cyst fluid obtained during endoscopic ultrasound fine needle aspiration (EUS-FNA) and 2) compare IMP profiles in pancreatic cyst fluid from BD-IPMNs and inflammatory cysts. Pancreatic cyst fluid from ten patients (5 BD-IPMN and 5 inflammatory cysts) was obtained by EUS-FNA and analyzed directly with a multiplexed microarray assay to determine concentrations of 89 IMPs. Statistical analysis was performed using non-parametric methods.


RESULTS
Eighty-three of the 89 assayed IMPs were detected in at least one of the 10 patient samples. Seven IMPs were detected in BD-IPMN but not inflammatory cysts, while eleven IMPs were identified in inflammatory cysts but not BD-IPMN. Notably, granulocyte-macrophage colony-stimulating factor (GM-CSF) expression was present in all five inflammatory cyst samples. Hepatocyte growth factor (HGF) was present in significantly higher concentrations in inflammatory cysts compared to BD-IPMN.


CONCLUSIONS
Our exploratory analysis reveals that GM-CSF and HGF in EUS-FNA-collected pancreatic cyst fluid can distinguish between BD-IPMN and inflammatory cyst. Coupling microarray molecular techniques to EUS-FNA may represent a major step forward to our understanding complex pancreatic disease.
Center for Pancreatic Disease, Division of Gastroenterology Hepatology and Endoscopy, Brigham and Women's Hospital and Department of Medicine, Harvard Medical School, Boston, MA.
Linda S
LS
Lee
Center for Pancreatic Disease, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Department of Medicine, Harvard Medical School, Boston, MA.
Peter A
PA
Banks
Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA.
Andrew M
AM
Bellizzi
Department of Radiology, Brigham and Women's Hospital, Boston, MA.
Nisha I
NI
Sainani
Center for Pancreatic Disease, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Department of Medicine, Harvard Medical School, Boston, MA.
Vivek
V
Kadiyala
Center for Pancreatic Disease, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Department of Medicine, Harvard Medical School, Boston, MA.
Shadeah
S
Suleiman
Center for Pancreatic Disease, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Department of Medicine, Harvard Medical School, Boston, MA.
Darwin L
DL
Conwell
Department of Pathology, Children's Hospital Boston, Boston, MA Proteomics Center at Children's Hospital Boston, Boston, MA Center for Pancreatic Disease, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Department of Medicine, Harvard Medical School, Boston, MA.
Joao A
JA
Paulo
D000368:Aged; D044963:Biopsy, Fine-Needle; D021441:Carcinoma, Pancreatic Ductal / Q000276:immunology*; D020420:Cyst Fluid / Q000737:chemistry* / Q000276:immunology; D016207:Cytokines / Q000032:analysis*; D019160:Endosonography; D005260:Female; D006801:Humans; D007249:Inflammation; D018836:Inflammation Mediators / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010181:Pancreatic Cyst / Q000737:chemistry* / Q000276:immunology; D010190:Pancreatic Neoplasms / Q000276:immunology*; D040081:Protein Array Analysis / Q000379:methods*
D016207:Cytokines; D018836:Inflammation Mediators