Researchers Identify Biomarker for Noncancerous Pancreatic Cysts


Key Points

  • The researchers found that high levels of VEGF-A in pancreatic cyst fluid indicate with 99% accuracy that the cyst will not become malignant.
  • This novel biomarker may eliminate the need for extensive follow-up and potentially harmful surgical interventions for patients with unrecognized benign cysts.

Researchers at the Indiana University School of Medicine have discovered a highly accurate, noninvasive test to identify benign pancreatic cysts, which could spare patients the cost and risk of surveillance or potentially dangerous surgical intervention. The findings are reported in the Journal of the American College of Surgeons.

According to the National Cancer Institute, about 45,220 people will be diagnosed this year with pancreatic cancer and about 38,460 will die from the disease. 

New Test Has High Level of Accuracy

The test, which analyzes fluid from pancreatic cysts, can identify a common type of benign cyst that can’t be differentiated by imaging alone from cysts that may progress to pancreatic cancer.

Pancreatic cyst fluid is tested for a biomarker, a specific isoform of vascular endothelial growth factor A (VEGF-A). Pancreatic cyst fluid is often obtained in patients with pancreatic cysts as a part of standard testing during endoscopy. After analyzing the results of 87 patients, the researchers found that high levels of VEGF-A indicate with 99% accuracy that the cyst will not become malignant.

This is the first cyst fluid protein biomarker that can differentiate serous cystic neoplasms, a benign type of cystic lesion, from all other cancerous or precancerous cystic lesions without surgery, according to first author Michele T. Yip-Schneider, PhD, Associate Research Professor of Surgery, and senior author C. Max Schmidt, MD, PhD, MBA, Professor of Surgery, Biochemistry, and Molecular Biology.

Sparing Patients Unnecessary Treatment

“Only 15% of pancreatic cancer patients will benefit from surgery, and of those, only about 20% will survive 5 years,” Dr. Schmidt said, adding that complications from pancreatic surgery are common and can be life-threatening, so sparing a patient unnecessary surgery is important.

“As scientists, we have tried to figure out which cystic lesions are benign, which are precancerous, and which are malignant,” Dr. Yip-Schneider said. “Although pancreatic cysts are best seen on pancreatic MRI-MRCP, making a diagnosis of which type of cyst and how likely it is that cancer will develop is not usually possible through imaging alone.”

Today, about 3% of the U.S. population has pancreatic cysts, although many are asymptomatic and go undiagnosed. Most of these cysts are precancerous, but some are completely benign while others are cancerous. Patients go through extensive follow-up medical visits, invasive biopsies, and sometimes unnecessary surgery to determine the true nature of their pancreatic cyst. The novel marker VEGF-A can completely eliminate the need for this extensive follow-up and potential harm for patients with unrecognized benign cysts, the researchers said.

“Many of my patients, when initially told they have pancreatic cysts, are very fearful and ask for surgical removal of the cyst or the entire pancreas before they even learn their options,” Dr. Schmidt said. “Now, physicians will have an outpatient procedure to offer that can take some of the guesswork out of the equation.”

Dr. Yip-Schneider is the corresponding author for the Journal of the American College of Surgeons article.

The study received financial support from the Indiana Genomics Initiative of Indiana University, supported in part by Lilly Endowment, Inc. Dr. Schmidt is a paid advisor for Redpath Integrated Pathology, Inc, and Asurgen, Inc. He is founder of B9, Inc, and has a VEGF-A use patent pending.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.