Post written by Iris J.M. Levink, MD, from the Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.

We aimed to develop a panel of biomarkers from serum and pancreatic juice (PJ) to detect pancreatic ductal adenocarcinoma for future surveillance purposes.

This study focused on the performance of proteins (interleukin-8 [IL-8]; interferon-γ [IFN-γ]; neutrophil gelatinase-associated lipocalin [NGAL]; mucin 5, subtype AC [MUC5AC]; and mucin 2 [MUC2]) in PJ compared with carbohydrate antigen 19-9 (CA19-9) in serum for the detection of early pancreatic cancer.

To date, surveillance of individuals at risk of developing pancreatic cancer has not lived up to expectations, as identification of curable stages through imaging remains challenging. Biomarkers are therefore needed. PJ may be a promising source because it is in direct contact with the ductal epithelial lining from which pancreatic cancer arises.

In addition, compared with collection by cannulation via endoscopic retrograde pancreatography, secretin-stimulated collection is safe and less invasive.

We assessed the diagnostic performance of promising protein biomarkers in serum and PJ for pancreatic cancer and high-grade dysplasia detection. Study results showed that concentrations of CA19-9 and IL-8 (not NGAL, MUC5AC, MUC2, and IFN-γ) in serum, and IL-8, NGAL, MUC5AC, and MUC2 (not IFN-γ) in PJ are significantly higher in cases than in controls.

CA19-9 in serum and IL-8 and NGAL in PJ were associated with pancreatic cancer, independent of age, gender, body mass index, and presence of diabetes mellitus. A panel of these 3 markers was able to differentiate between cases and control subjects with a specificity and positive predictive value of 100%, which is higher than that achieved with serum CA19-9 alone.

Future prospective studies are needed to validate this panel in a longitudinal surveillance cohort and to investigate if combining these proteins with other biomarker types or imaging results in increased sensitivity and may allow earlier identification of pancreatic cancer patients.

Graphical Abstract

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