Are there new metabolic or CYST related malignancy predictors in pancreatic CYSTS?

Background: Early diagnosis of neoplastic cysts is important for prognosis as they have the potential of malignancy. The aim of this study is to find a marker in pancreatic cyst fluids related to premalignancy and provide an opportunity of treatment before malignancy occurs. Material and Methods: In our study, 100 patients above the age of 18 who were referred to endoscopy unit for pancreatic cyst aspiration between 2020-2022 were evaluated. 53 of these patients were eligible for FNA and were included in this study. Demographical features, history of pancreatitis, alcohol consumption, imaging features of cysts; LDH, total protein, glucose, CEA, amilase, lipase, triglyceride, cholesterol of serum and cystic fluid, serum-cyst albumin gradient, serum-cyst glucose rate, cyst cytology and EUS findings were obtained. Patients were divided into 2 groups as benign and premalign/malign cysts according to cytology or surgical specimen. SPSS 26.0 was used for statistical analysis. Results: Of the 53 patients, 29 were male (54.7%). Mean age was 55±15 years and mean follow-up period was 11.1±5.8 months. There were no statistically significant differences between the malign and benign groups in terms of solid nodule presence, contrast enhancement, alcohol abuse and history of pancreatitis. Albumin, total protein, glucose, CEA, cholesterol of cystic fluid, serum-cyst albumin gradient and serum-cyst glucose rate were significantly different between malign and benign groups. Cut-off values were determined via ROC analysis. Odds ratios (OR) for cyst albumin<0.63 g/dl, cyst total protein<1 g/dl, cyst glucose<100 mg/dl, cyst CEA>24 ng/ml, cyst cholesterol<4.5 mg/dl, serum-cyst albumin gradient>2.5 and serum-cyst glucose rate>1.3 were: 29 (p:0.005, %95 CI: 2.7-306), 27 (p:0.006, %95 CI: 2.5-284), 8.4 (p:0.01, %95 CI: 1.6-42), 9.2 (p:0.003, %95 CI: 2.1-39.5), 17.5 (p:0.019, %95 CI: 1.5-191), 16 (p:0.022, %95 CI: 1.4-171) and 13 (p:0.006, %95 CI: 2- 81), respectively. Conclusion: High CEA, low glucose, albumin, cholesterol and total protein levels in cyst fluid as well as high serum-cyst albumin gradient and serum-cyst glucose rate are simple, practically usable markers for predicting malignancy in pancreatic cysts.