Cyst Fluid Carcinoembryonic Antigen Is an Accurate Diagnostic Marker of Pancreatic Mucinous Cysts

Çizginer, Sevdenur; Turner, Brian G.; Bilge, A Reyyan; Karaca, Çetin; Pitman, Martha B.; Brugge, William R.

doi:10.1097/mpa.0b013e31821bd62f

Cited by 271 publications

(219 citation statements)

References 28 publications

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“…8,11 Studies from our department have indicated that, although CEA analysis is the best test for detecting a mucinous cyst, our data also have revealed that cytologic analysis is the best test for detecting malignancy. 22 Others have demonstrated that detecting atypical cells on cytologic analysis also was the most sensitive test for malignancy compared with imaging studies. 16,17 -in which a ''suspicious'' for malignancy interpretation rather than a ''positive'' cytologic interpretation, as indicated in the 2006 guidelines, is a high-risk feature for malignancy along with an enhancing mural nodule and a dilated main pancreatic duct (!10 mm).…”

Section: Discussionmentioning

confidence: 99%

Prospective analysis of atypical epithelial cells as a high‐risk cytologic feature for malignancy in pancreatic cysts

Pitman

Yaeger

Brugge

et al. 2012

Cancer Cytopathology

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BACKGROUND: Pancreatic cysts are aspirated to assess whether a cyst is mucinous on one hand and malignant on the other. The authors' retrospective data have indicated that high-grade atypical epithelial cells (AECs) identified on cytology are a high-risk feature and a better threshold than ''positive'' for detecting malignancy. The objective of the current study was to assess the accuracy of AECs in predicting malignancy in pancreatic cysts.

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Section: Discussionmentioning

confidence: 99%

Prospective analysis of atypical epithelial cells as a high‐risk cytologic feature for malignancy in pancreatic cysts

Pitman

Yaeger

Brugge

et al. 2012

Cancer Cytopathology

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“…This result is sufficiently powered to demonstrate a significant improvement over cytology ( P =0.002), which has an accuracy of 58% (95% CI: 50%–65%) 7 . The resulting sensitivity is 90% (95% CI: 60–98%) and specificity is 100% (95% CI: 76–100%).…”

Section: Discussionmentioning

confidence: 78%

“…This procedure has an overall sensitivity of less than 50% for detecting malignancy with the majority of results being non-diagnostic 6,7 . During the EUS-FNA procedure the cyst fluid is collected and then analyzed both for tissue (cytopathology) evaluation, and also for the presence of certain molecular markers or glycoproteins, such as carcinoembryonic antigen (CEA).…”

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confidence: 99%

Light scattering spectroscopy identifies the malignant potential of pancreatic cysts during endoscopy

et al. 2017

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Pancreatic cancers are usually detected at an advanced stage and have poor prognosis. About one fifth of these arise from pancreatic cystic lesions. Yet not all lesions are precancerous, and imaging tools lack adequate accuracy for distinguishing precancerous from benign cysts. Therefore, decisions on surgical resection usually rely on endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Unfortunately, cyst fluid often contains few cells, and fluid chemical analysis lacks accuracy, resulting in dire consequences, including unnecessary pancreatic surgery for benign cysts and the development of cancer. Here, we report an optical spectroscopic technique, based on a spatial gating fibre-optic probe, that predicts the malignant potential of pancreatic cystic lesions during routine diagnostic EUS-FNA procedures. In a double-blind prospective study in 25 patients, with 14 cysts measured in vivo and 13 postoperatively, the technique achieved an overall accuracy of 95%, with a 95%confidence interval of 78–99%, in cysts with definitive diagnosis.

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“…Cytology is the most accurate test for the detection of malignancy in patients with mucinous cysts. 21 A cytological diagnosis of ''positive'' or ''malignant'' is generally 100% specific but very insensitive for detecting highgrade dysplasia. 30,31 Aspirating the contents of the cyst is really a screening test for the detection of dysplastic cells, akin to a Papanicolaou test.…”

Section: Commentary 362mentioning

confidence: 99%

“…Studies have shown that concentrations of around 110 to 200 ng/mL are approximately 80% accurate in determining a cyst to be mucinous. 13,[21][22][23][24][25] Raising the cutoff level improves the specificity of the test but at the expense of sensitivity. 24 Not all mucinous cysts will have such an elevated CEA concentration, and some mucinous cysts have very low concentrations of CEA.…”

Section: Commentary 362mentioning

confidence: 99%

Revised international consensus guidelines for the management of patients with mucinous cysts

Pitman

2012

Cancer Cytopathology

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The management of patients with pancreatic cysts is a significant issue in the health care community. We know from over 30 years of study that mucinous cysts account for a significant percentage of pancreatic cysts, and that mucinous cysts are precursors of pancreatic carcinoma. Based on autopsy studies, approximately 2.6% of the adult population and nearly 8% of elderly patients have a pancreatic cyst.1 How many of these cysts are mucinous and, of those that are mucinous, how many are malignant or sufficiently highgrade to prompt surgical management is a conundrum physicians are facing on an increasingly common basis. 2,3 The detection of mucinous cysts before the development of invasive carcinoma is the goal of management given that invasion is the single most important factor determining patient prognosis. 4Understanding the clinicopathological features of pancreatic cysts is critical in answering the important question of whether surgical management is warranted, and this requires a multidisciplinary approach. 5,6In 2005, an international and multidisciplinary group of physicians met in Sendai, Japan and developed a consensus document to guide physicians in the diagnosis and management of patients with pancreatic mucinous cysts (also known as the ''Sendai guidelines''). 7 In brief, these guidelines called for the conservative management of asymptomatic patients with pancreatic mucinous cysts that were small (< 3 cm), not associated with a dilated main pancreatic duct (MPD) ( 6 mm) or mural nodule by imaging, and without ''positive cytology.'' Since their publication in 2006, studies have shown the Sendai guidelines to be highly sensitive (approximately 97%), but very nonspecific (approximately 29%) for the detection of a malignant mucinous cyst. [8][9][10] Cyst size and nonspecific patient symptoms have proven to be poor predictors of malignancy. 11,12 Although the majority of patients with cancer were detected, many patients already had invasive cancers at the time of surgical resection. In addition, many elderly patients with significant comorbid conditions and mucinous cysts with low-to intermediate-grade (moderate) dysplasia were also undergoing surgical resection, which is riskier than conservative follow-up because the progression to carcinoma would likely take longer than the expected life expectancy of the patient. Most importantly, some asymptomatic patients with carcinoma or high-grade dysplasia but with no high-risk imaging features were being followed conservatively. 12,13In 2010, a new international, multidisciplinary group of physicians (the 8 members of the original group plus 6 new physicians from various specialties) met in Fukuoka, Japan to revisit the Sendai guidelines and to discuss advances in the understanding of the biology, imaging, preoperative testing, and surgical management of patients with mucinous cysts, with the goal of providing a revised management algorithm.14 Because the levels

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Cyst Fluid Carcinoembryonic Antigen Is an Accurate Diagnostic Marker of Pancreatic Mucinous Cysts

Abstract: Cyst fluid CEA concentration provides a highly accurate test for the diagnosis of a mucinous cyst, but does not distinguish benign from malignant cysts. Cytology is the most accurate test for the diagnosis of a malignant cyst.

Cited by 271 publications

References 28 publications

Prospective analysis of atypical epithelial cells as a high‐risk cytologic feature for malignancy in pancreatic cysts

Prospective analysis of atypical epithelial cells as a high‐risk cytologic feature for malignancy in pancreatic cysts

Light scattering spectroscopy identifies the malignant potential of pancreatic cysts during endoscopy

Revised international consensus guidelines for the management of patients with mucinous cysts

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