Background: Pancreatic cystic lesions (PCLs) are frequently detected incidentally and vary from benign to malignant. Accurate differentiation between mucinous (M-PCLs) and non-mucinous PCLs (NM-PCLs) is essential for appropriate management. This study aims to validate the accuracy of on-site glucose measurement using a glucometer with a cut-off of 50 mg/dL for distinguishing M-PCLs from NM-PCLs. Methods: In this prospective multicenter study, conducted at three European academic hospitals, patients who underwent endoscopic ultrasound-guided fine-needle aspiration for PCLs between 2019 and 2020 were included. On-site glucose measurement was performed using a conventional glucometer. Data on demographics, clinical features, EUS findings, and histopathology were collected. Results: Fifty patients were enrolled, with 37 having glucose levels < 50 mg/dL and 13 ≥ 50 mg/dL. M-PCLs were more common in the <50 mg/dL group (81%) compared to the ≥50 mg/dL group (23%,p< 0.001). The median CEA was higher in the <50 mg/dL group (146 ng/mL) than in the ≥50 mg/dL group (3 ng/mL,p= 0.047). On-site glucose testing < 50 mg/dl demonstrated a sensitivity of 93.2%, a specificity of 76.5%, and an accuracy of 89% for detecting M-PCLs with an AUC of 0.74 and an OR of 14.29 (p< 0.001). In comparison, CEA > 192 ng/mL had a sensitivity of 55.6%, a specificity of 87.5%, and an accuracy of 75.8% for M-PCLs, with an AUC of 0.65 and an OR of 4.44. Conclusions: On-site glucose measurement using a glucometer with a cut-off of <50 mg/dL is a highly accurate, rapid, and cost-effective method for differentiating M-PCLs from NM-PCLs. Our results validate the glucose cut-off in a multicentric prospective cohort supporting its integration into standard diagnostic protocols for PCLs.
背景：胰腺囊性病变（PCLs）常为偶然发现，其性质可从良性到恶性不等。准确区分黏液性（M-PCLs）与非黏液性PCLs（NM-PCLs）对临床决策至关重要。本研究旨在验证使用血糖仪进行现场葡萄糖检测（以50 mg/dL为临界值）在区分M-PCLs与NM-PCLs中的准确性。方法：这项前瞻性多中心研究在欧洲三家教学医院开展，纳入2019年至2020年间接受超声内镜引导下细针穿刺的PCLs患者。使用常规血糖仪进行现场葡萄糖检测，同时收集人口统计学、临床特征、超声内镜表现及组织病理学数据。结果：共纳入50例患者，其中37例葡萄糖水平<50 mg/dL，13例≥50 mg/dL。与≥50 mg/dL组（23%）相比，<50 mg/dL组中M-PCLs更常见（81%，p<0.001）。<50 mg/dL组CEA中位数（146 ng/mL）显著高于≥50 mg/dL组（3 ng/mL，p=0.047）。以<50 mg/dL为临界值的现场葡萄糖检测诊断M-PCLs的敏感性为93.2%，特异性为76.5%，准确率达89%，曲线下面积为0.74，比值比为14.29（p<0.001）。相比之下，CEA>192 ng/mL诊断M-PCLs的敏感性为55.6%，特异性为87.5%，准确率为75.8%，曲线下面积0.65，比值比4.44。结论：采用<50 mg/dL临界值的血糖仪现场葡萄糖检测是一种高准确性、快速且经济的方法，可用于区分M-PCLs与NM-PCLs。本研究结果在多中心前瞻性队列中验证了该葡萄糖临界值的有效性，支持将其纳入PCLs的标准诊断流程。
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