Usefulness of Human Telomerase Reverse Transcriptase in Pancreatic Juice as a Biomarker of Pancreatic Malignancy

Objectives: Human telomerase reverse transcriptase (hTERT), one of the subunits of telomerase, is a promising diagnostic marker for pancreatic cancer. In the present study, we did a large-scale analysis of 115 preoperative pancreatic juice specimens to evaluate the feasibility of detection of hTERT expression by immunohistochemistry for preoperative diagnosis of pancreatic malignancy. Methods: The expression of hTERT was examined by immunohistochemistry in preoperative pancreatic juice samples. Results: In pancreatic juice samples, hTERT expression was detectable in 84% of pancreatic ductal adenocarcinomas (PDACs), whereas 62% of PDACs were positive by cytology. In intraductal papillary mucinous neoplasms (IPMNs), hTERT expression was detectable in 88% of malignant IPMNs, whereas only 22% were positive by cytology. The sensitivity, specificity, and overall accuracy of hTERT expression for differentiation between carcinoma and other benign diseases were 85.1%, 82.1%, and 84.3%, respectively, whereas the same values for cytologic accuracy were 47.1%, 89.3%, and 57.4%, respectively. When the results of cytology and hTERT expression were combined, the sensitivity and overall accuracy increased to 92.0% and 87.8%, respectively. Conclusions: Our results suggested that the assessment of hTERT expression in preoperative pancreatic juice increased the sensitivity and accuracy of diagnosis of PDACs and malignant IPMNs without using special techniques.Abbreviations: PDAC - pancreatic ductal adenocarcinoma, IPMN - intraductal papillary mucinous neoplasm, hTERT - human telomerase reverse transcriptase, IHC - immunohistochemistry, ERCP - endoscopic retrograde cholangiopancreatography, EUS-FNA - endoscopic ultrasound-guided fine-needle aspiration

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