P Moutinho-Ribeiro1, B Adem2, I Batista3, M Silva1, S Silva4, C F Ruivo2, R Morais1, A Peixoto1, R Coelho1, P Costa-Moreira1, S Lopes1, F Vilas-Boas1, C Durães3, J Lopes5, H Barroca5, F Carneiro6, S A Melo7, G Macedo8. 1. Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal. 2. Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal. 3. Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal. 4. Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal; iBiMED - Institute of Biomedicine, University of Aveiro. 5. Serviço de Anatomia Patológica, Centro Hospitalar Universitário de São João, Porto, Portugal. 6. Medical Faculty of the University of Porto, Porto, Portugal; Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal; Serviço de Anatomia Patológica, Centro Hospitalar Universitário de São João, Porto, Portugal. 7. Medical Faculty of the University of Porto, Porto, Portugal; Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal. 8. Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal. Electronic address: guilhermemacedo59@gmail.com.
Abstract
BACKGROUND AND AIMS: Pancreatic ductal adenocarcinoma (PDAC) diagnosis can be difficult in a chronic pancreatitis (CP) background, especially in its mass forming presentation. We aimed to assess the accuracy of glypican-1-positive circulating exosomes (GPC1+crExos) to distinguish PDAC from CP versus the state-of-the-art CA 19-9 biomarker. METHODS: This was a unicentric prospective cohort. Endoscopic ultrasound with fine-needle aspiration or biopsy and blood tests (GPC1+crExos and serum CA 19-9) were performed. RESULTS: The cohort comprised 60 PDAC and 29 CP (7 of which mass forming - MF) patients. Median levels of GPC1+crExos were significantly higher in PDAC (99.7%) versus CP (28.4%; p<0.0001) with an AUROC of 0.96 with 98.3% sensitivity and 86.2% specificity for a cut-off of 45.0% (p<0.0001); this outperforms CA 19-9 AUROC of 0.82 with 78.3% sensitivity and 65.5% specificity at a cut-off of 37 U/mL (p<0.0001). The superiority of% GPC1+crExos over CA 19-99 in differentiating PDAC from CP was observed in both early (stage I) and advanced tumors (stages II-IV). CONCLUSION: Levels of GPC1+crExos coupled to beads enable differential diagnosis between PDAC and CP including its mass-forming presentation.
BACKGROUND AND AIMS: Pancreatic ductal adenocarcinoma (PDAC) diagnosis can be difficult in a chronic pancreatitis (CP) background, especially in its mass forming presentation. We aimed to assess the accuracy of glypican-1-positive circulating exosomes (GPC1+crExos) to distinguish PDAC from CP versus the state-of-the-art CA 19-9 biomarker. METHODS: This was a unicentric prospective cohort. Endoscopic ultrasound with fine-needle aspiration or biopsy and blood tests (GPC1+crExos and serum CA 19-9) were performed. RESULTS: The cohort comprised 60 PDAC and 29 CP (7 of which mass forming - MF) patients. Median levels of GPC1+crExos were significantly higher in PDAC (99.7%) versus CP (28.4%; p<0.0001) with an AUROC of 0.96 with 98.3% sensitivity and 86.2% specificity for a cut-off of 45.0% (p<0.0001); this outperforms CA 19-9 AUROC of 0.82 with 78.3% sensitivity and 65.5% specificity at a cut-off of 37 U/mL (p<0.0001). The superiority of% GPC1+crExos over CA 19-99 in differentiating PDAC from CP was observed in both early (stage I) and advanced tumors (stages II-IV). CONCLUSION: Levels of GPC1+crExos coupled to beads enable differential diagnosis between PDAC and CP including its mass-forming presentation.
Authors: Pedro Moutinho-Ribeiro; Ines A Batista; Sofia T Quintas; Bárbara Adem; Marco Silva; Rui Morais; Armando Peixoto; Rosa Coelho; Pedro Costa-Moreira; Renato Medas; Susana Lopes; Filipe Vilas-Boas; Manuela Baptista; Diogo Dias-Silva; Ana L Esteves; Filipa Martins; Joanne Lopes; Helena Barroca; Fátima Carneiro; Guilherme Macedo; Sonia A Melo Journal: World J Gastroenterol Date: 2022-08-21 Impact factor: 5.374