Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study

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

“…1a) and described as a possible side-branch IPMN. EUS-FNA cyst fluid resulted in a CEA of 686 ng/ml, significantly higher than the 192 ng/ml cut-off suggestive of a mucinous lesion 6,25 . Cytology reported scant acellular debris which could not be further categorized.…”

“…Recently, a large multicenter prospective clinical study evaluated both cytology and CEA for their ability to diagnose mucinous cystic lesions based on EUS-FNA in 341 patients. Pancreatic surgical resections of 112 of these patients found that cytology of cyst fluid has a sensitivity of 35% and a specificity of 83% for diagnosing mucinous vs. non-mucinous cysts and just 22% sensitivity for detecting mucinous cystic cancers 6 . Apart from CEA, the diagnostic potential of other molecular markers including amylase 40 , cancer antigen (CA) 19-9 41,42 , DNA 43 , and fluid viscosity 44 have been investigated, with CEA being the only marker that achieves enough accuracy to be of clinical utility.…”

“…Despite the recent improvements in CT and MRI methodologies, these imaging approaches are unable to distinguish cancerous, premalignant and benign cysts reliably, in part due to a lack of sensitivity to cellular structure and biochemical properties, with wide variations in the reported accuracy ranging from 20% to 80% 37 . EUS is still the most sensitive technique currently available for the detection of small (<2–3 cm) pancreatic cysts 38,39 , however, the accuracy of EUS for distinguishing mucinous from non-mucinous cysts is only 51% 6 . Because imaging techniques have a limited ability of identifying the type of pancreatic cyst, there has been a major effort to identify the cyst type with cyst fluid obtained during EUS-FNA procedures.…”

“…Apart from CEA, the diagnostic potential of other molecular markers including amylase 40 , cancer antigen (CA) 19-9 41,42 , DNA 43 , and fluid viscosity 44 have been investigated, with CEA being the only marker that achieves enough accuracy to be of clinical utility. However, CEA addition provides only a slight improvement over cytology alone in distinguishing between benign and mucinous cysts 6 . Due to the limited performance of existing cytological and molecular markers, a strong need is present to augment existing cyst fluid analysis approaches with an accurate diagnostic test.…”

“…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).…”