Characteristics of cyst fluid can predict the benign or malignant nature of intraductal papillary mucinous neoplasms

doi:10.16139/j.1007-9610.2025.06.09

Abstract

Abstract:

Objective To investigate the predictive ability of cyst fluid characteristics for malignant intraductal papillary mucinous neoplasms (IPMNs). Methods We prospectively collected fresh cyst fluid from patients undergoing pancreatic resection at the Department of Hepatobiliary Pancreatic Spleen Surgery, Changhai Hospital, Shanghai, from September 2023 to December 2024, who were ultimately pathologically confirmed with IPMN. We assessed the characteristics of cyst fluid, including viscosity, clarity, and color, and explored its predictive performance for benign or malignant. Results A total of 40 patients with IPMN were included. The sensitivity of the string sign （+） for diagnosing high-grade dysplasia/ invasive carcinoma （HGD/IC） was 90.9%, specificity was 92.9%, and accuracy was 76.0%. The cyst fluid of intestinal-type IPMN often exhibited a gelatinous consistency, and there was no significant difference in the distribution of gelatinous consistency between the HGD/IC group and the low-grade dysplasia （LGD） group. There were no significant differences in CEA, glucose, and amylase levels in the cyst fluid between the HGD/IC group and the LGD group. Conclusions The characteristics of pancreatic cyst fluid, especially viscosity, can effectively predict the benign or malignant nature of IPMN.

Key words: Intraductal papillary mucinous neoplasm （IPMN）, Characteristics of cyst fluid, String sign, Morphological subtype, Grade of dysplasia

CLC Number:

R657.5

WANG Jingyuan, FAN Jiayu, ZHANG Pingping, MA Hongyun, CHEN Ying, LI Gang, JIN Zhendong, JIN Gang, WANG Kaixuan. Characteristics of cyst fluid can predict the benign or malignant nature of intraductal papillary mucinous neoplasms[J]. Journal of Surgery Concepts & Practice, 2025, 30(06): 509-516.

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Characteristics	HGD/IC (n=19)	LGD (n=21)	Test statistic	P value
Gender			χ²=0.852	0.356
Male	9 (47.4)	13 (61.9)
Female	10 (52.6)	8 (38.1)
Age at surgery	60.68±1.84	61.90±1.75	t=0.481	0.633
Cyst location			/	0.050
Head&Neck	13 (68.4)	13 (61.9)
Body&Tail	2 (10.5)	8 (38.1)
Whole	4 (21.1)	0
Type of IPMN			/	0.125
BD-IPMN	8 (42.1)	6 (28.6)
MD-IPMN	2 (10.5)	0
MT-IPMN	9 (47.4)	15 (71.4)
Serum CEA	2.20 (1.92,2.96)	2.77 (1.53,3.69)	U=213	0.728
Serum CA19-9	20.79 (13.49,23.96)	21.39 (18.05,24.09)	U=221	0.573
Acute pancreatitis secondary to the cyst			χ²=0.151	0.698
Present	7 (36.8)	9 (42.9)
Absent	12 (63.2)	12 (57.1)
Obstructive jaundice caused by cystic lesion of the head of the pancreas			χ²=1.67	0.196
Present	3 (15.8)	0
Absent	16 (84.2)	21 (100.0)
An enhancing mural nodule≥5 mm or solid component			χ²=15.506	<0.001
Present	12 (63.2)	1 (4.8)
Absent	7 (36.8)	20 (95.2)
Diameter of main pancreatic duct			U=224	0.520
<5 mm	6 (31.6)	3 (14.3)
≥5 mm~<10 mm	9 (47.4)	14 (66.7)
≥10 mm	4 (21.0)	4 (19.0)
Main pancreatic duct stenosis with upstream pancreatic atrophy			χ²=1.160	0.281
Present	4 (21.1)	1 (4.8)
Absent	15 (78.9)	20 (95.2)
Diameter of cyst			χ²=0.351	0.554
<30 mm	10 (52.6)	13 (61.9)
≥30 mm	9 (47.4)	8 (38.1)
New onset or acute exacerbation of diabetes within past one year			/	0.219
Present	2 (10.5)	0
Absent	17 (89.5)	21 (100.0)
Lymphadenopathy			χ²=0.008	0.928
Present	2 (10.5)	1 (4.8)
Absent	17 (89.5)	21(95.2)
Thickened/enhancing cyst wall			χ²=0.001	1.000
Present	5 (26.3)	5 (23.8)
Absent	14 (73.7)	16 (76.2)

Characteristics	Classification	Grade of dysplasia		Test statistic	P value
Characteristics	Classification	HGD/IC（n=19）	LGD（n=21）	Test statistic	P value
Viscosity	String sign (-)	1 (5.3)	13 (61.9)	U=117.5	0.025
	String sign (+)	10 (52.6)	1 (4.8)
	Gelatinous	8 (42.1)	7 (33.3)
Clarity	Clear	9 (47.4)	18 (85.7)	χ²=6.686	0.01
Clarity	Turbid	10 (52.6)	3 (14.3)	χ²=6.686	0.01
Color	Colorless	4 (21.05)	10 (47.6)	U=138.0	0.099
	Yellow	4 (21.05)	3 (14.3)
	Red	9 (47.4)	8 (38.1)
	Brown	2 (10.5)	0

Characteristics	Classification	Grade of dysplasia		P value
Characteristics	Classification	HGD/IC（n=11）	LGD（n=14）	P value
String sign	(-)	1(9.1)	13(92.9)	<0.001
	(+)	10(90.9)	1(7.1)
Clarity	Clear	6(54.5)	14(100.0)	0.009
	Turbid	5(45.5)	0
String sign combined with clarity	(-)	1(9.1)	13(92.9)	<0.001
	(+)	10(90.9)	1(7.1)

Characteristics	Grade of dysplasia		Mann-Whitney U value	P value
Characteristics	HGD/IC	LGD	Mann-Whitney U value	P value
Cyst fluid CEA （μg/L）	21.12 (17.87, 23.88)	22.94 (18.32, 23.8)	157	0.397
Cyst fluid glucose（mmol/L）	1.04 (0.26, 1.61)	0.59 (0.25, 1.05)	101	0.540
Cyst fluid amylase（IU/L）	1363 (580, 4561)	3148 (991.5, 5770)	151	0.305

	Cyst fluid CEA	Cyst fluid glucose	Cyst fluid amylase	String sign	Clarity	String sign combined with clarity
Sensitivity（%）	28.6	53.8	61.5	90.9	45.5	90.9
Specificity（%）	94.7	72.2	63.2	92.9	100	92.9
Accuracy（%）	66.7	64.5	62.5	92.0	76.0	92.0