Intracystic glucose measurement for on-site differentiation between Mucinous and Non-Mucinous Pancreatic Cystic Lesions

Aims Pancreatic cystic lesions (PCLs) are frequently detected incidentally and vary from benign to malignant. Accurate differentiation between mucinous (M-PCLs) and non-mucinous PCLs (NM-PCLs) is essential for an appropriate management. Recent studies suggest that intracystic glucose is a promising biomarker for differential diagnosis. This study aims to validate the accuracy of on-site glucose measurement using a glucometer with a cut-off of 50 mg/dL for distinguishing M-PCLs from NM-PCLs.

Methods In this prospective multicenter study, conducted at three European academic hospitals, patients who underwent Endoscopic Ultrasound-Guided Fine Needle Aspiration for PCLs between 2019 and 2020 were included. On-site glucose measurement was performed using a conventional glucometer. Data on demographics, clinical features, EUS findings, and histopathology were collected.

Results Fifty patients were enrolled, with 37 (74%) having glucose levels<50 mg/dL and 13 (26%)≥50 mg/dL. M-PCLs were more common in the<50 mg/dL group (81%) compared to the≥50 mg/dL group (23%, p<0.001). The median Carcinoembryonic Antigen (CEA) was higher in the<50 mg/dL group (146 ng/mL) than in the≥50 mg/dL group (3 ng/mL, p=0.047).

On-site glucose testing<50 mg/dl demonstrated a sensitivity of 93.2%, specificity of 76.5%, and accuracy of 89% for detecting M-PCLs with an Area Under the Curve (AUC) of 0.74 and an OR of 14.29 (95% CI: 3.09 to 65.99, p<0.001). In comparison, CEA>192 ng/mL had a sensitivity of 55.6%, specificity of 87.5%, and accuracy of 75.8% for M-PCLs, with an AUC of 0.65 and an OR of 4.44 (95% CI: 0.74 to 26.68).

Conclusions On-site glucose measurement using a glucometer with a cut-off of<50 mg/dL is a highly accurate, rapid, and cost-effective method for differentiating M-PCLs from NM-PCLs.

Our results validate the glucose cut-off in a multicentric prospective cohort supporting its integration into standard diagnostic protocols for PCLs.

Publication History

Article published online:
27 March 2025