A Lower Cyst Fluid CEA Cut-Off Increases Diagnostic Accuracy in Identifying Mucinous Pancreatic Cystic Lesions

  • David X Jin Department of Internal Medicine, Hospital of the University of Pennsylvania. Philadelphia, PA, USA
  • Aaron J Small Department of Internal Medicine, Hospital of the University of Pennsylvania. Philadelphia, PA, USA
  • Charles M Vollmer Department of Surgery, Hospital of the University of Pennsylvania. Philadelphia, PA, USA
  • Nirag Jhala Department of Payhology, Hospital of the University of Pennsylvania. Philadelphia, PA, USA
  • Emma E Furth Department of Payhology, Hospital of the University of Pennsylvania. Philadelphia, PA, USA
  • Gregory G Ginsberg Department of Internal Medicine, Hospital of the University of Pennsylvania. Philadelphia, PA, USA
  • Michael L Kochman Department of Internal Medicine, Hospital of the University of Pennsylvania. Philadelphia, PA, USA
  • Nuzhat A Ahmad Department of Internal Medicine, Hospital of the University of Pennsylvania. Philadelphia, PA, USA
  • Vinay Chandrasekhara Department of Internal Medicine, Hospital of the University of Pennsylvania. Philadelphia, PA, USA
Keywords: Carcinoembryonic Antigen, Pancreatic Cyst

Abstract

Context Carcinoembryonic antigen analysis of pancreatic cyst fluid is the tumor marker of choice for preoperatively differentiating mucinous from non-mucinous cystic lesions. Objective We aim to determine the most accurate cyst carcinoembryonic antigen cut-off value for distinguishing mucinous cysts from non-mucinous cysts with a focus on discriminating intraductal papillary mucinous neoplasms. Methods The results of pancreatic cyst aspiration carcinoembryonic antigen levels from a single center were retrospectively collected and evaluated for a diagnosis of a mucinous cyst and an assessment of malignancy using surgical histology as the diagnostic standard in 86 patients. Results The median cyst carcinoembryonic antigen level (ng/mL) was significantly higher in mucinous cysts compared with non-mucinous cysts (218 vs. 4.4; P=0.0006) and in intraductal papillary mucinous neoplasms compared with non-mucinous cysts (135 vs. 4.4; P=0.0027). A cyst carcinoembryonic antigen cut-off of 30.7 ng/mL was most accurate (87.2%) for differentiating mucinous from non-mucinous cysts and specifically for differentiating intraductal papillary mucinous neoplasms from non-mucinous cysts (82.7%). Cyst carcinoembryonic antigen levels were not significantly different between malignant and non-malignant mucinous cysts (68.5 vs. 238.1; P=0.51). Conclusions Pancreatic cyst fluid carcinoembryonic antigen can accurately differentiate histologically verified mucinous lesions, including intraductal papillary mucinous neoplasms, from non-mucinous lesions with an optimal cut-off that is much lower than previously reported values. Cyst carcinoembryonic antigen levels are not a reliable predictor of malignancy.

Image: Sensitivity and specificity curves of cyst fluid CEA levels for differentiating mucinous from non-mucinous cysts.

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Sensitivity and specificity curves of cyst fluid CEA levels for differentiating mucinous from non-mucinous cysts
Published
2015-05-20
How to Cite
JinD., SmallA., VollmerC., JhalaN., FurthE., GinsbergG., KochmanM., AhmadN., & ChandrasekharaV. (2015). A Lower Cyst Fluid CEA Cut-Off Increases Diagnostic Accuracy in Identifying Mucinous Pancreatic Cystic Lesions. JOP. Journal of the Pancreas, 16(3), 271-277. https://doi.org/10.6092/1590-8577/2994
Section
ORIGINAL ARTICLES