الفهرس 
The value of pancreatic cyst fluid SPINK1 in differentiating cysts of malignant potential from those of benign nature
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Abstract
Background: Differential diagnosis of pancreatic cyst lesions is challenging as there is currently no investigation that offers both high diagnostic sensitivity and specificity for the identification of potentially malignant cysts. Accurate classification of these lesions is vital in order to avoid unnecessary treatment of benign lesions and missed opportunities for early treatment of potentially malignant lesions. Previous studies have found that serine protease inhibitor Kazal type I (SPINK1) is a promising new marker for detection of potentially malignant cysts. Metabolomics analysis of cyst fluid in previous studies showed cyst fluid glucose as a marker for differentiation of mucinous from non-mucinous cysts. Aims: to validate the previously suggested value of cysts fluid SPINK1 and glucose in differentiating mucinous from non-mucinous cysts.Methods: A prospective study was conducted on 80 patients presenting with pancreatic cystic lesion {u2265}10 mm in diameter referred for EUS-FNA in the period from June 2018 to October 2019. EUS evaluation of detailed cyst morphology and EUS-FNA were done. Fluid analysis for carcinoembryonic antigen (CEA), glucose and SPINK1 and cytopathology were done. We compared these data with the final diagnosis based on cytopathological examination and follow up of the patients for 6 months.Results: The mean age of the studied population was 49 ± 11.75 years with 45 (56.25%) females. Cyst fluid SPINK1 was significantly higher in malignant/potentially malignant cysts compared to benign cysts (0.91 vs 0.47, P value = 0.001). Also glucose was markedly lower in malignant/potentially malignant cysts compared to benign cysts (21.5 vs 68.5, P value = 0.0001). CEA was significantly higher in malignant/potentially malignant cysts than in benign cysts (84.65 vs 2.86 ng/ml, P value = 0.0002)