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.
Keywords
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Article info
Publication history
Published online: November 25, 2021
Accepted:
October 27,
2021
Received:
July 8,
2021
Identification
Copyright
© 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
