Diagnostic Value Of Mucins Expression Profile In Aspiration Specimens Of The Pancreas

Effective new markers of pancreatic carcinoma and pancreatic rrucinous neoplasms are urgently needed. We have analyzed 54 EUS-FNA samples from pancreaticoccupying lesion to detect mucins (MUC1,MUC2,MUC5AC) expression. These results were compared with the cytohistologic diagnosis according to the final clinical general diagnosis as standard for pancreatic cancer and mucinous neoplasms to evaluate the potential value of the mucins expression pattern in diagnosis of pancreatic cancer and mucinous neoplasms. 38 of the 54 patients were ultimately diagnosed pancreatic cancer , 6 benign tumor , 10 chronic pancreatitis, 18 pancreatic mucinous neoplasms (12 malignant mucinous neoplasms),36 non-mucinous neoplasms. The sensitivity of cytohistology in diagnosis of pancreatic cancer and mucinous neoplasms was 50% and 55.6%, respectively. Immunohistochemical studies revealed that the prevalence of MUCl, MUC2 and MUC5AC expression in EUS-FNA samples of pancreatic cancer were 81.6%(31/38), 10.5%(4/38), 84.2%(32/38), respectively, and in benign pancreatic diseases were 25%(4/16), 31,3% (5/16) , 43.8%(7/16), respectively. There was statistically significant difference in the MUCl and MUC5AC expression between two groups (P<0.01) . Furthermore MUCl expression in pancreatic cancer had positive relationship with clinical stage and lymphatic metastasis. The prevalence of MUCl, MUC2 and MUC5AC expression in 18 EUS-FNA samples of pancreatic mucinous neoplasms were 66.7%(12/18), 38.9%(7/18), 88.9%(16/18), respectively, and in 38 pancreatic non-mucinous neoplasms were 63.9% (23/36), 5.6% (2/36) , 61 .l%(22/36), respectively. There was statistically significant difference in the MUC2 and MUC5AC expression between two groups (P< 0.05). The combination test of MUC1 + cytology, and MUC5AC + cytology could achieve higher sensitivity and accuracy in pancreatic cancer diagnosis, while MUC2 + cytology, and MUC5AC + cytology could achieve higher sensitivity, specificity and accuracy in mucinous neoplasm diagnosis. The expression profile "MUC1+/MUC2-/MUC5AC+" was noted in 27 of 40 pancreatic cancers without in any of the benign pancreatic diseases (0 of 16). While the expression profile "MUC1-/MUC2+/MUC5AC+" was noted in 6 of 18 mucinous neoplasms without in any of the non-mucinous neoplasms (0 of 38). Our observations suggest mucins expression profile are potentially useful new tumor marker for the diagnosis of pancreatic cancer and mucinous neoplasms and can achieve higher accuracy rate combined with cytohistologic analysis. MUC1 would in addition aid in predicting the clinical stage and lymphatic metastasis of cancer.