title: Cyst Fluid Glucose is Rapidly Feasible and Accurate in Diagnosing Mucinous Pancreatic Cysts.
abstract: OBJECTIVE
  Better diagnostic tools are needed to differentiate pancreatic cyst subtypes. A previous metabolomic study showed cyst fluid glucose as a potential marker to differentiate mucinous from non-mucinous pancreatic cysts. This study seeks to validate these earlier findings using a standard laboratory glucose assay, a glucometer, and a glucose reagent strip.
  
  
  METHODS
  Using an IRB-approved prospectively collected bio-repository, 65 pancreatic cyst fluid samples (42 mucinous and 23 non-mucinous) with histological correlation were analyzed.
  
  
  RESULTS
  Median laboratory glucose, glucometer glucose, and percent reagent strip positive were lower in mucinous vs. non-mucinous cysts (P<0.0001 for all comparisons). Laboratory glucose<50 mg/dl had a sensitivity of 95% and a specificity of 57% (LR+ 2.19, LR- 0.08). Glucometer glucose<50 mg/dl had a sensitivity of 88% and a specificity of 78% (LR+ 4.05, LR- 0.15). Reagent strip glucose had a sensitivity of 81% and a specificity of 74% (LR+ 3.10, LR- 0.26). CEA had a sensitivity of 77% and a specificity of 83% (LR+ 4.67, LR- 0.27). The combination of having either a glucometer glucose<50 mg/dl or a CEA level>192 had a sensitivity of 100% but a low specificity of 33% (LR+ 1.50, LR- 0.00).
  
  
  CONCLUSIONS
  Glucose, whether measured by a laboratory assay, a glucometer, or a reagent strip, is significantly lower in mucinous cysts compared with non-mucinous pancreatic cysts.
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zikos
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Pham
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Raffick
authors.initials: R
authors.lastname: Bowen
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Chen
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Subhas
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Shai
authors.initials: S
authors.lastname: Friedland
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Monica M
authors.initials: MM
authors.lastname: Dua
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Norton
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Poultsides
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Visser
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Walter G
authors.initials: WG
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis / Q000378:metabolism*; D044963:Biopsy, Fine-Needle; D002272:Carcinoembryonic Antigen / Q000032:analysis / Q000378:metabolism*; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000378:metabolism; D020420:Cyst Fluid / Q000737:chemistry*; D003536:Cystadenocarcinoma / Q000175:diagnosis / Q000378:metabolism; D018282:Cystadenocarcinoma, Mucinous / Q000175:diagnosis / Q000378:metabolism; D005260:Female; D005947:Glucose / Q000032:analysis / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000175:diagnosis* / Q000378:metabolism; D010181:Pancreatic Cyst / Q000175:diagnosis* / Q000378:metabolism; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000378:metabolism; D010192:Pancreatic Pseudocyst / Q000175:diagnosis / Q000378:metabolism; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D005947:Glucose