E0017 - Benefits of Using Pancreatic Cyst Fluid Glucose in Community-Based Setting to Evaluate Pancreatic Cystic Lesions

Grace Hawley, BA¹, Sanjay Jagannath, ², Farah S. Hussain, MD³, Raja Vadlamudi, MD, MPH^1
1Raleigh Medical Group Gastroenterology, Raleigh, NC; ²RMG Gastroenterology, Raleigh, NC; ³RMG, Raleigh, NC

Introduction: In the evaluation of incidental asymptomatic pancreatic cystic lesions (PCLs), it is necessary to identify mucinous cysts due to their risk for malignant transformation.1 Current guidelines recommend obtaining cyst fluid carcinoembryonic antigen (f-CEA), but this test has limitations.2 Recently, a low cyst fluid glucose level (f-Glu) < 50 mg/dl has emerged as an alternative to f-CEA.3

Methods: Patients from 11/2021-4/2022 with a PCL were retrospectively analyzed. Demographics, radiology & EUS findings, & test results were collected. f-CEA and f-Glu were ordered on each patient, with priority placed on f-CEA, followed by f-Glu.

Results: 13 patients (7 M:6 F, median age 74) with PCLs were analyzed. The median cyst size was 27 mm (16.8-77 mm), and the median fluid volume obtained was 1.5 mL (0-170 mL). In our patients, both f-CEA and f-Glu were available in 46% (6/13), only f-CEA in 2/13 (15%), and only f-Glu in 3/13 (23%). In 2 patients, f-CEA/f-Glu could not be obtained.



In 6 patients, when both f-CEA and f-Glu were available, there was 100% agreement between the two test results. In 5/13 cases, f-CEA could not be obtained. In 2 cases, f-Glu was the only test result that was obtained.

Discussion: Since pancreatic f-Glu has emerged as an alternative to f-CEA,3 we aimed to incorporate f-Glu in evaluating PCLs in our community-based EUS program. In our study, f-Glu did correlate with f-CEA results. Unfortunately, in a community hospital, f-CEA requires >3 mL for analysis. In contrast, f-Glu requires >1 mL, and is readily available, making it an ideal alternative to f-CEA. In our series, the median fluid volume aspirated was 1.5 mL, and in 38% of cases, f-CEA could not be obtained. In 69% of cases, f-Glu was measured despite low fluid volume (< 3 mL), making it advantageous in the evaluation of a PCL. In this limited series, f-Glu was a more favorable alternative to f-CEA in a community-based EUS program.




1. Fernandez-del Castillo C, et al. Incidental pancreatic cysts: Clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg 2003;138:427-433.
2. Gaddam S, et al. Suboptimal accuracy of carcinoembryonic antigen in differentiation of mucinous and nonmucinous pancreatic cysts: Results of a large multicenter study. Gastrointest Endosc 2015;82:1060-1069.
3. Lopes C, et al. Cyst fluid glucose: An alternative to carcinoembryonic antigen for pancreatic mucinous cysts. 2019; p25(19), 2271–2278.



Disclosures:


Grace Hawley, BA¹, Sanjay Jagannath, ², Farah S. Hussain, MD³, Raja Vadlamudi, MD, MPH¹. E0017 - Benefits of Using Pancreatic Cyst Fluid Glucose in Community-Based Setting to Evaluate Pancreatic Cystic Lesions, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.