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mAb Das-1 is specific for high-risk and malignant intraductal papillary mucinous neoplasm (IPMN)
  1. Koushik K Das1,
  2. Hong Xiao2,
  3. Xin Geng3,
  4. Carlos Fernandez-del-Castillo4,
  5. Vicente Morales-Oyarvide2,4,
  6. Ebubekir Daglilar5,
  7. David G Forcione5,
  8. Brenna C Bounds5,
  9. William R Brugge5,
  10. Martha B Pitman2,
  11. Mari Mino-Kenudson2,
  12. Kiron M Das3
  1. 1Department of Internal Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
  2. 2Department of Pathology, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
  3. 3Division of Gastroenterology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
  4. 4Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
  5. 5Division of Gastroenterology, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Mari Mino-Kenudson, Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Warren 122, Boston, MA 02114, USA; mminokenudson{at}partners.org Koushik K Das, Division of Gastroenterology, Department of Medicine, University of Pennsylvania, 1 Convention Ave, 9 Penn Tower, Philadelphia, PA 19104, USA; koushik.das@uphs.upenn.edu.

Abstract

Objective Intraductal papillary mucinous neoplasm (IPMN) consists of four epithelial subtypes that correlate with histological grades and risks for malignant transformation. mAb Das-1 is a monoclonal antibody against a colonic epithelial phenotype that is reactive to premalignant conditions of the upper GI tract. We sought to assess the ability of mAb Das-1 to identify IPMN with high risk of malignant transformation.

Design mAb Das-1 reactivity was evaluated in 94 patients with IPMNs by immunohistochemistry. Lesional fluid from 38 separate patients with IPMN (n=27), low-grade non-mucinous cystic neoplasms (n=7) and pseudocysts (n=4) was analysed by ELISA and western blot.

Results Immunohistochemistry—Normal pancreatic ducts were non-reactive and low-grade gastric-type IPMN (IPMN-G) (1/17) and intermediate-grade IPMN-G (1/23) were minimally reactive with mAb Das-1. In contrast, mAb Das-1 reactivity was significantly higher in high-risk/malignant lesions (p<0.0001) including: intestinal-type IPMN with intermediate-grade dysplasia (9/10); high-grade dysplasia of gastric (4/7), intestinal (12/12), oncocytic (2/2) and pancreatobiliary types (2/2); and invasive tubular (8/12), colloid (7/7) and oncocytic (2/2) carcinoma. The sensitivity and specificity of mAb Das-1 for high-risk/malignantIPMNs were 85% and 95%, respectively. Lesional fluid—Samples from low- and intermediate-grade IPMN-G (n=9), and other low-grade/benign non-mucinous lesions demonstrated little reactivity with mAb Das-1. Conversely, cyst fluid from high-risk/malignant IPMNs (n=18) expressed significantly higher reactivity (p<0.0001). The sensitivity and specificity of mAbDas-1 in detecting high-risk/malignant IPMNs were 89% and 100%, respectively.

Conclusions mAb Das-1 reacts with high specificity to tissue and cyst fluid from high-risk/malignant IPMNs and thus may help in preoperative clinical risk stratification.

  • Pancreatic Cancer
  • Pancreatic Tumours
  • Pancreatic Pathology

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