Mucin Profiling of Pancreatic Cysts to Improve Pancreatic Cancer Detection

Dr. Karolina Sjöberg Jabbar, MD, Medicine Policlinic II, Bla Straket 5, Sahlgrenska University Hospital Gothenburg, Interview with
Dr. Karolina Sjöberg Jabbar, MD,

Medicine Policlinic II, Bla Straket 5, Sahlgrenska University Hospital
Gothenburg, Sweden What are the main findings of the study?

Answer: The main finding of this study is that the presence of mucin proteins in pancreatic cyst fluid, as evaluated by mass spectrometry, can predict with high accuracy (97%) which pancreatic cysts contain premalignant and malignant tumours. This is important, given that pancreatic cystic lesions are an increasingly common incidental finding on imaging. While most of them pose no threat to the patient, a minor proportion has malignant potential, and may be considered precursors to pancreatic cancer. Were any of the findings unexpected?

Answer: On the one hand they were not, as we did not have to change our hypotheses during the course of the study. However, on the other hand, we were ourselves surprised that the method performed so well. What should clinicians and patients take away from your report?

Answer: First, I think it is very important to increase the awareness among both physicians and patients about pancreatic cystic lesions. They are a common finding, and most of them will probably never be noticed by the patient, still some cysts have the potential to develop into cancer. Identifying this sub-group at an early stage provides a therapeutic window that allows for curative or preventive treatment.

The method we have developed is based on mass spectrometry analysis of cyst fluid obtained through endoscopic ultrasound-guided fine needle aspiration. The analysis is focused on the detection of a type of protein called mucins. We hope that it will come to be useful for the assessment of those pancreatic cystic lesions where clinical data and imaging results do not provide sufficient information to guide treatment decisions. This means, that if our results can be confirmed by further studies, our method could in the future be used to determine which pancreatic cystic lesions require surgery or follow-up, and which may safely be left alone. We are hopeful that clinical introduction of the new method might improve pancreatic cancer prevention, as well as reduce the risk of unnecessary operations for benign cysts. What recommendations do you have for future research as a result of this study?

Answer: As I mentioned previously, I should first of all like to see our results corroborated by further studies. There is also room for methodological improvement. Although the suggested approach already appears compatible with clinical requirements, it may be optimized to allow for quantitation, faster processing and higher throughput. Finally, I, like the whole medical community and indeed the whole world, of course hope to see the development of a non-invasive test that could be used to detect early pancreatic cancer. If our results could help pave the way towards that goal it would be truly fantastic.

Proteomic Mucin Profiling for the Identification of Cystic Precursors of Pancreatic Cancer

Karolina S. Jabbar, Caroline Verbeke, Anders G. Hyltander, Henrik Sjövall, Gunnar C. Hansson, and Riadh Sadik

JNCI J Natl Cancer Inst (2014) 106 (2): djt439 doi:10.1093/jnci/djt439