Test ID: AMLPC
Amylase, Pancreatic Cyst
NY State Approved 
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Aids in distinguishing between pseudocysts and other types of pancreatic cysts, when used in conjunction with imaging studies, cytology, and other pancreatic cyst fluid tumor markers
Method Name A short description of the method used to perform the test
Substrate Kinetic
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Collection Container/Tube: Body fluid container
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | NA |
| Lipemia | NA |
| Icterus | NA |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Pancreatic Cyst Fluid | Frozen (preferred) | 30 days |
| Refrigerated | 7 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Amylases are a group of hydrolases that degrade complex carbohydrates into fragments. Amylase is produced by the exocrine pancreas and the salivary glands to aid in the digestion of starch. It is also produced by the small intestine mucosa, ovaries, placenta, liver, and fallopian tubes.
Measurement of amylase in pancreatic cyst fluid is often used in conjunction with tumor markers, carcinoembryonic antigen and CA19-9, as an aid in the differential diagnosis of pancreatic cysts lesions. Amylase seems to be particularly helpful in excluding pancreatic pseudocysts. A number of studies have demonstrated that amylase levels are typically very high, usually in the thousands in pseudocysts, therefore, low amylase values virtually excludes pseudocysts. Based on the evidence available, the American College of Gastroenterology (ACG) practice guidelines for the Diagnosis and Management of Neoplastic Pancreatic Cysts suggest that an amylase cutoff value of 250 U/L is useful to exclude pseudocysts.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
An interpretive report will be provided.
Interpretation Provides information to assist in interpretation of the test results
A pancreatic cyst fluid amylase concentration of <250 U/L indicates a low risk of a pseudocyst and is more consistent with cystic neoplasms such as mucinous cystic neoplasms (MCN), intraductal papillary mucinous neoplasm (IPMN), serous cystadenomas, cystic neuroendocrine tumor, and mucinous cystadenocarcinoma. High pancreatic cyst fluid amylase values are nonspecific and occur both in pseudocysts and some mucin-producing cystic neoplasms including MCN, IPMN, and mucinous cystadenocarcinoma.
In-house studies to verify this cutoff value showed that 94% (66/70) of pseudocysts had a value of > or =250 U/L. Cysts with amylase levels of <250 U/L included 69% of adenocarcinomas, 31% of intraductal papillary mucinous neoplasia, 55% of mucinous cystadenomas, 64% serous cystadenomas, and 6% of pseudocysts. Therefore, using a cutoff of <250 U/L to exclude a pseudocyst has 94% sensitivity and 42% specificity.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
This test result should not be the sole basis for diagnosis. Test results should always be correlated with imaging and cytology.
Supportive Data
In-house studies to verify the cutoff value of 250 U/L showed that 94% (66/70) of pseudocysts had a value of > or =250 U/L. Cysts with amylase levels of <250 U/L included 69% of adenocarcinomas, 31% of intraductal papillary mucinous neoplasia, 55% of mucinous cystadenomas, 64% serous cystadenomas, and 6% of pseudocysts. Therefore, using a cutoff of <250 U/L to exclude a pseudocyst has 94% sensitivity and 42% specificity.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Snozek CL, Mascarenhas RC, O'Kane DJ: Use of cyst fluid CEA, CA19-9, and amylase for evaluation of pancreatic lesions. Clin Biochem 2009;42:1585-1588
2. van der Waaij LA, van Dullemen HM, Porte RJ: Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis. Gastrointest Endosc 2005;62:383-389
3. Khalid A, Brugge W: ACG practice guidelines for the diagnosis and management of neoplastic pancreatic cysts. Am J Gastroenterol 2007;102:2339-2349
Method Description Describes how the test is performed and provides a method-specific reference
This test is performed on the Roche Cobas c501. The Roche amylase (AMYL) method is an enzymatic colorimetric test using 4,6-ethyliden (G7)-p-nitrophenol (G1)-a, D-maltoheptaoside (ethylidene-G7PNP) as a substrate. Human salivary and pancreatic amylase (alpha-amylase) convert the substrate at approximately the same rate. The alpha-amylase cleaves the substrate into G2, G3, G4 PNP fragments. The G2, G3, and G4 PNP fragments are further hydrolyzed by an a-glucosidase to yield p-nitrophenol and glucose. The rate of increase in absorbance at 415 nm (measuring the increase in p-nitrophenol) is proportional to amylase activity.(Package insert: Roche AMYL reagent, Roche Diagnostic Corp, Indianapolis, IN, 2/00)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Friday; Varies
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
82150
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| AMYPC | Amylase, Pancreatic Cyst | In Process |
| SITE6 | Site | N/A |
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