Detection of soluble biomarkers of pancreatic cancer in endoscopic ultrasound-guided fine-needle aspiration samples

Background Biomarkers are urgently needed for pancreatic ductal adenocarcinoma (PDAC). Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the cornerstone for diagnosing PDAC. We developed a method for discovery of PDAC biomarkers using the discarded EUS-FNA liquid. Methods This retrospective study included 58 patients with suspected pancreatic lesions who underwent EUS-FNA. Protein extracts from EUS-FNA liquid were analyzed by mass spectrometry. Proteomic and clinical data were modeled by supervised statistical learning to identify protein markers and clinical variables that distinguish PDAC. Results Statistical modeling revealed a protein signature for PDAC screening that achieved high sensitivity and specificity (0.92, 95% confidence interval [CI] 0.79-0.98, and 0.85, 95 %Cl 0.67-0.93, respectively). We also developed a protein signature score (PSS) to guide PDAC diagnosis. In combination with patient age, the PSS achieved 100% certainty in correctly identifying PDAC patients>54 years. In addition, 3 /4 inconclusive EUS-FNA biopsies were correctly identified using PSS. Conclusions EUS-FNA-derived fluid is a rich source of PDAC proteins with biomarker potential. The PSS requires further validation and verification of the feasibility of measuring these proteins in patient sera.

Automated summary

Protein signature for PDAC screening with high sensitivity and specificity was discovered using protein extracts from EUS-FNA liquid. The combination of PSS and patient age achieved 100% certainty in identifying PDAC patients. The study also showed that PSS accurately identified inconclusive EUS-FNA biopsies.