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• W2920931966 abstract "Introduction: Pancreatic cysts (PCs) are seen on abdominal imaging in 2-3% of the population. While not all PCs are premalignant, mucinous cysts (MCs), including intraductal pancreatic papillary mucinous neoplasm (IPMN) and mucinous cystic neoplasm (MCN), have malignant potential and early identification is important. Current guidelines recommend interval surveillance of PCs with MRI or EUS. Cyst fluid analysis is indicated for PCs with high risk features. Repeated surveillance can be costly and burdensome to patients. A few studies have shown cyst fluid glucose levels (CFGLs) to be useful in identification of MCs. We present our case series assessing the diagnostic utility of CFGLs. Methods: The case records of a single operator (MD) including patients with PCs over a 2 year period were reviewed. 8 patients were identified with PC who had undergone EUS with FNA and cyst fluid analysis. In addition to cytology, analysis included CEA, amylase, and glucose levels. Results: Table 1 shows characteristics for each patient. CFGL was very low (<11 mg/dL) in all premalignant or malignant lesions including IPMN, MCN, and adenocarcinoma, whereas CFGLs were significantly higher (49-242mg/dL) in patients with benign lesions. Conclusion: Although there is limited data on CFGL measurement, prior studies have shown significantly lower CFGLs in MCs compared to nonmucinous cysts (Table 2). The mechanism behind decreased glucose levels in PCs with malignant potential is unclear but may be related to cell turnover rate. CEA level is currently the most widely accepted cyst fluid marker, however specificity for detection of MCs is 63-77%. In prior studies, CFGL muchlower than the threshold suggested in these studies (11 vs. 50-66). Our data suggest that the absolute CFGL may be of prognostic importance. Very low CFGL was an adverse prognostic factor and levels around 100 mg/dL or greater correlated with a relatively benign prognosis. Recently the ACG has partnered with the American College of Physicians in their Choosing Wisely campaign to champion high value, cost-conscious health care. In accordance with this initiative, CFGL measurement has the potential to add high value to the management of PCs, as glucose measurement is inexpensive and widely available. The exact role of CFGL in the algorithmic approach to diagnosis and surveillance of PCs has yet to be determined.2721_A Figure 1. Patient characteristics and data2721_B Figure 2. Data from prior studies on CFGL" @default.
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• W2920931966 date "2018-10-01" @default.
• W2920931966 modified "2023-09-23" @default.
• W2920931966 title "Pancreatic Cyst Fluid Glucose Levels as a Diagnostic Marker: Do Absolute Levels Matter?" @default.
• W2920931966 doi "https://doi.org/10.14309/00000434-201810001-02720" @default.
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