GNAS and KRAS mutations were not found in benign cysts, although KRAS mutations did appear occasionally in a rare type of cyst with a relatively low potential to become cancerous. These rare, mostly benign cysts are less challenging to diagnose because of their location within the pancreas and type of patient, according to the investigators.
"There has long been a need for accurate, quantitative ways to identify cysts that are more worrisome and to help patients avoid unnecessary surgeries for harmless cysts," says Vogelstein, the Clayton Professor of Oncology at the Johns Hopkins Kimmel Cancer Center.
"Most cysts are benign," says pathologist Ralph Hruban, M.D., director of Hopkins' Sol Goldman Pancreatic Cancer Research Center, "but distinguishing between the harmless and dangerous ones is challenging for doctors and patients alike."
Generally, patients with a cyst that appears harmless and is less than 3 cm in size are monitored to watch for growth of the cyst or other concerning features such as a solid nodule. With cysts that appear more worrisome, surgical removal is often recommended, but the procedure requires removal of a portion of the pancreas as well, and complications like a pancreatic fistula (fluid from the pancreas leaks through the surgical incision), eating difficulties and prolonged recovery can develop, according to Christopher Wolfgang, M.D., Ph.D., associate professor of surgery, pathology and oncology and director of pancreatic surgery at Johns Hopkins.
CT scans, MRI imaging, and enzyme and secreted antigen levels in cyst fluid are imprecise markers for precancerous potential, adds Wolfgang.
Genetic analysis of the kind reported in the new study offers a new way to sort the potential of these cysts to cause malignant trouble.
The investigators caution that cyst fluid removal, an invasive procedure, also has its caveats and can cause bleeding
|Contact: Vanessa Wasta|
Johns Hopkins Medical Institutions