Clin Endosc.  2021 Jan;54(1):113-121. 10.5946/ce.2020.083.

Cyst Fluid Carcinoembryonic Antigen Level Difference between Mucinous Cystic Neoplasms and Intraductal Papillary Mucinous Neoplasms

• Köker IH
• Ünver N
• Malya F
• Uysal
• Keskin EB
• Şentürk H

• KMID: 2512316
• DOI: http://doi.org/10.5946/ce.2020.083

Abstract

Background/Aims
The role of cyst fluid carcinoembryonic antigen (CEA) level in differentiating mucinous pancreatic cystic lesions (PCLs) is controversial. We investigated the role of cyst fluid CEA in differentiating low-risk (LR)-intraductal papillary mucinous neoplasms (IPMNs) from high-risk (HR)-IPMNs and LR-mucinous cystic neoplasms (MCNs).
Methods
This was a retrospective study of 466 patients with PCLs who underwent endoscopic ultrasound-guided fine-needleaspiration over a 7-year period. On histology, low-grade dysplasia and intermediate-grade dysplasia were considered LR, whereas high-grade dysplasia and invasive carcinoma were considered HR.
Results
Data on cyst fluid CEA levels were available for 50/102 mucinous PCLs with definitive diagnoses. The median CEA (range) levels were significantly higher in HR cysts than in LR cysts (2,624 [0.5–266,510] ng/mL vs. 100 [16.8–53,445]ng/mL, p=0.0012). The area under the receiver operating characteristic curve (AUROC) was 0.930 (95% confidence interval [CI], 0.5–0.8; p<0.001) for differentiating LR-IPMNs from LR-MCNs. The AUROC was 0.921 (95% CI, 0.823–1.000; p<0.001) for differentiating LR-IPMNs from HR-IPMNs. Both had a CEA cutoff level of >100ng/mL, with a negative predictive value (NPV) of 100%.
Conclusions
Cyst fluid CEA levels significantly vary between LR-IPMNs, LR-MCNs, and HR-IPMNs. A CEA cutoff level of >100ng/mL had a 100% NPV in differentiating LR-IPMNs from LR-MCNs and HR-IPMNs.

Keyword

Carcinoembryonic antigen; Malignancy; Pancreatic cysts

Figure

• 

  Fig. 1. Flowchart of the patients recruited to the study. CEA, carcinoembryonic antigen; EUS, endoscopic ultrasound; FNA, fine-needle aspiration; HR, high risk; IPMN, intraductal papillary mucinous neoplasm; LR, low risk; MCN, mucinous cystic neoplasm; PCL, pancreatic cystic lesion; PDAC, pancreatic ductal adenocarcinoma.

• 

  Fig. 2. The -axis represents a logarithmic scale (ng/mL) for carcinoembryonic antigen (CEA). Median values are presented as the center lines within every box. The width of each box represents the interquartile range. The whiskers show the minimum and maximum values. Outliers are shown above the boxes. IPMN, intraductal papillary mucinous neoplasm; MCN, mucinous cystic neoplasm; PDAC, pancreatic ductal adenocarcinoma.

• 

  Fig. 3. Receiver operating characteristic (ROC) curve analysis to differentiate low-risk mucinous cystic neoplasms from low-risk intraductal papillary mucinous neoplasms. A cyst fluid carcinoembryonic antigen cutoff level of >100 ng/mL resulted in an area under the ROC of 0.93 (95% confidence interval, 0.5–0.8).

• 

  Fig. 4. Receiver operating characteristic (ROC) curve analysis to differentiate high-risk from low-risk intraductal papillary mucinous neoplasms. A cyst fluid carcinoembryonic antigen cutoff level of >100 ng/mL resulted in an area under the ROC of 0.92 (95% confidence interval, 0.82–1.0).

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