Cyst Fluid Carcinoembryonic Antigen Level Is not Predictive of Invasive Cancer in Patients with Intraductal Papillary Mucinous Neoplasm of the Pancreas

  • Stephen Kucera University of Cincinnati. Cincinnati, OH, USA
  • Barbara A Centeno Moffitt Cancer Center. Tampa, FL, USA
  • Gregory Springett Moffitt Cancer Center. Tampa, FL, USA
  • Mokenge P Malafa Moffitt Cancer Center. Tampa, FL, USA
  • Yian Ann Chen Moffitt Cancer Center. Tampa, FL, USA
  • Jill Weber Moffitt Cancer Center. Tampa, FL, USA
  • Jason Klapman Moffitt Cancer Center. Tampa, FL, USA
Keywords: Carcinoembryonic Antigen, Carcinoma, Intraductal, Noninfiltrating, Cyst Fluid, Endosonography, Papilloma

Abstract

Context Cyst fluid CEA concentration >192ng/mL has proven accurate to differentiate mucinous from non-mucinous pancreatic cystic neoplasms. It is unclear whether the degree of cyst fluid CEA elevation is predictive of malignant behavior in IPMNs. Objectives To determine whether elevated cyst fluid CEA concentrations were predictive of invasive cancer. Design Cross sectional study. Setting Single National Cancer Institute comprehensive cancer care center experience. Patients Forty-seven patients underwent preoperative EUS-FNA with cyst fluid analysis and surgical resection of an IPMN over a 9 year period. Main outcome measurements Cyst fluid CEA concentrations among the four grades associated with IPMN (low grade dysplasia, moderate dysplasia, high grade dysplasia, and invasive cancer). Results The mean±standard deviation cyst fluid CEA concentration increased as the pathology progressed from low grade dysplasia (1,261±1,679 ng/mL) to moderate dysplasia (7,171±22,210 ng/mL) to high grade dysplasia (10,807±36,203 ng/mL). However, the mean CEA level decreased (462±631 ng/mL) once invasive cancer developed (P=0.869). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of a cyst fluid CEA concentration greater than 200 ng/mL for the diagnosis of malignant IPMN (cases of high grade dysplasia and invasive IPMN) was 52.4%, 42.3%, 42.3%, 52.4% and 46.8%, respectively. Limitations Single center experience, small patient numbers, retrospective data collection. Conclusion The degree of cyst fluid CEA elevation is a poor predictor of malignant degeneration within IPMNs. Clinical management decisions regarding surgical resection should not be based upon degree of cyst fluid CEA elevation.

Image: Box-plot comparing pre-operative CEA levels with surgical pathology.

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Author Biographies

Stephen Kucera, University of Cincinnati. Cincinnati, OH, USA

Assistant Professor of Clinical Medicine

Division of Digestive Diseases

Barbara A Centeno, Moffitt Cancer Center. Tampa, FL, USA

Professor of Medicine

Department of Anatomic Pathology

Gregory Springett, Moffitt Cancer Center. Tampa, FL, USA

Assistant Professor of Medicine

Department of Medical Oncology

 

Mokenge P Malafa, Moffitt Cancer Center. Tampa, FL, USA

Associate Professor of Medicine

Chair, Department of Gastrointestinal Oncology

Section Head, Pancreatic Oncology

Yian Ann Chen, Moffitt Cancer Center. Tampa, FL, USA
Department of Biostatistics
Jason Klapman, Moffitt Cancer Center. Tampa, FL, USA

Associate Professor of Medicine

Section of Endoscopic Oncology

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Box-plot comparing pre-operative CEA levels with surgical pathology
Published
2012-07-10
How to Cite
KuceraS., CentenoB., SpringettG., MalafaM., ChenY., WeberJ., & KlapmanJ. (2012). Cyst Fluid Carcinoembryonic Antigen Level Is not Predictive of Invasive Cancer in Patients with Intraductal Papillary Mucinous Neoplasm of the Pancreas. JOP. Journal of the Pancreas, 13(4), 409-413. https://doi.org/10.6092/1590-8577/664
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ORIGINAL ARTICLES