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Open Access Research article

Diagnostic accuracy of cyst fluid amphiregulin in pancreatic cysts

May T Tun1, Reetesh K Pai2, Shirley Kwok2, Aiwen Dong1, Aparna Gupta1, Brendan C Visser3, Jeff A Norton3, George A Poultsides3, Subhas Banerjee1, Jacques Van Dam5, Ann M Chen1, Shai Friedland1, Brennan A Scott4, Rahul Verma4, Anson W Lowe16* and Walter G Park1

Author affiliations

1 Department of Medicine, Stanford University, Stanford, CA 94305, USA

2 Department of Pathology, Stanford University, Stanford, CA 94305, USA

3 Department of General Surgery, Stanford University, Stanford, CA 94305, USA

4 Palo Alto Medical Foundation, Palo Alto, CA 94301, USA

5 Department of Medicine, University of Southern California, Los Angeles, CA 90033, USA

6 Always Building, Room M211, 300 Pasteur Drive, Stanford, CA 94305-5187, USA

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Citation and License

BMC Gastroenterology 2012, 12:15  doi:10.1186/1471-230X-12-15

Published: 14 February 2012



Accurate tests to diagnose adenocarcinoma and high-grade dysplasia among mucinous pancreatic cysts are clinically needed. This study evaluated the diagnostic utility of amphiregulin (AREG) as a pancreatic cyst fluid biomarker to differentiate non-mucinous, benign mucinous, and malignant mucinous cysts.


A single-center retrospective study to evaluate AREG levels in pancreatic cyst fluid by ELISA from 33 patients with a histological gold standard was performed.


Among the cyst fluid samples, the median (IQR) AREG levels for non-mucinous (n = 6), benign mucinous (n = 15), and cancerous cysts (n = 15) were 85 pg/ml (47-168), 63 pg/ml (30-847), and 986 pg/ml (417-3160), respectively. A significant difference between benign mucinous and malignant mucinous cysts was observed (p = 0.025). AREG levels greater than 300 pg/ml possessed a diagnostic accuracy for cancer or high-grade dysplasia of 78% (sensitivity 83%, specificity 73%).


Cyst fluid AREG levels are significantly higher in cancerous and high-grade dysplastic cysts compared to benign mucinous cysts. Thus AREG exhibits potential clinical utility in the evaluation of pancreatic cysts.