Transforming Growth Factor α Levels in Pancreatic Fluid

Objective: To determine if the level of transforming growth factor alpha (TGF-alpha) in the pancreatic fluid (PF) can diagnose intraductal papillary mucinous neoplasm (IPMN) versus other cystic lesions of the pancreas in patients. Methods: Pancreatic fluid was prospectively obtained from patients during routine endoscopy and/or operation at Indiana University Hospital. Pancreatic fluid TGF-alpha levels were analyzed by enzyme-linked immunosorbent assay. Intraductal papillary mucinous neoplasm tissue was also analyzed by TGF-alpha immunohistochemistry. Results: Sixty-nine fluid samples from 58 patients with the following pathologically confirmed pancreatic disorders were analyzed: IPMN (26 patients), serous cystadenoma (6), mucinous cystic neoplasm (9), pseudocysts (5), non-IPMN-associated pancreatic ductal adenocarcinoma (6), and sphincter of Oddi dysfunction (6). There was no significant difference between the mean PF-TGF-alpha levels in each category or between different dysplastic grades of IPMN. However, of all the diagnoses examined, only IPMN demonstrated PF-TGF-alpha levels greater than 95 pg/mL. In low-grade IPMN specimens, TGF-alpha immunohistochemistry correlated with enzyme-linked immunosorbent assay levels. Conclusions: The mean PF-TGF-alpha levels are not significantly different in IPMN lesions compared with those in other cystic pancreatic lesions, pancreatic ductal adenocarcinoma, or sphincter of Oddi dysfunction. However, PF-TGF-alpha levels more than 95 pg/mL may be useful in diagnosing IPMN. This assertion requires prospective validation.