Gut Liver.  2017 Mar;11(2):283-289. 10.5009/gnl15650.

The Combination of Cyst Fluid Carcinoembryonic Antigen, Cytology and Viscosity Increases the Diagnostic Accuracy of Mucinous Pancreatic Cysts

• Oh SH
• Lee JK
• Lee KT
• Lee KH
• Woo YS
• Noh DH

• KMID: 2412196
• DOI: http://doi.org/10.5009/gnl15650

Abstract

BACKGROUND/AIMS
The objective of this study was to investigate the value of cyst fluid carcinoembryonic antigen (CEA) in combination with cytology and viscosity for the differential diagnosis of pancreatic cysts.
METHODS
We retrospectively reviewed our data for patients who underwent endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and cyst fluid analysis. We investigated the sensitivity, specificity and accuracy of the combination of cyst fluid CEA, cytology and viscosity testing.
RESULTS
A total of 177 patients underwent EUS-FNA and cyst fluid analysis. Of these, 48 subjects were histologically and clinically confirmed to have pancreatic cysts and were therefore included in the analysis. Receiver operator curve analysis demonstrated that the optimal cutoff value of cyst fluid CEA for differentiating mucinous versus nonmucinous cystic lesions was 48.6 ng/mL. The accuracy of cyst fluid CEA (39/48, 81.3%) was greater than the accuracy of cytology (23/45, 51.1%) or the string sign (33/47, 70.2%). Cyst fluid CEA in combination with cytology and string sign assessment exhibited the highest accuracy (45/48, 93.8%).
CONCLUSIONS
Cyst fluid CEA was the most useful single test for identifying mucinous pancreatic cysts. The addition of cytology and string sign assessment to cyst fluid CEA increased the overall accuracy for the diagnosis of mucinous pancreatic cysts.

Keyword

Pancreatic cyst; Cyst fluid analysis; Cyst fluid carcinoembryonic antigen

MeSH Terms

Area Under Curve
*Carcinoembryonic Antigen
Cyst Fluid/*cytology
Cystadenoma, Mucinous/*diagnosis
Diagnosis, Differential
Female
Humans
Male
Middle Aged
Pancreatic Cyst/*diagnosis
Pancreatic Neoplasms/*diagnosis
Predictive Value of Tests
Retrospective Studies
Sensitivity and Specificity
Viscosity
Carcinoembryonic Antigen