Utility of endoscopic ultrasound, cytology and fluid carcinoembryonic antigen and CA 19-9 levels in pancreatic cystic lesions

Abstract

AIM:To assess the diagnostic accuracy of endoscopic ultrasound (EUS), fluid tumor markers and cytology in distinguishing benign from (pre)malignant pancreatic cystic lesions. METHODS:46 consecutive patients, referred to a gastroenterologist and surgeon for a symptomatic or incidental pancreatic cyst, were reviewed. EUS, cytology, and carcinoembryonic antigen (CEA) and carbohydrate antigen (CA 19-9) levels were compared with the final diagnosis, based on surgical pathology and/or imaging follow-up of at least 12 mo. Cysts were classified as benign (pseudocyst, serous cystadenoma) or malignant/ pre-malignant (mucinous cystic neoplasm). Receiveroperator characteristics (ROC) curve analysis was performed. RESULTS:The mean age was 56 years; 29% were male and median cyst diameter was 3 cm. Final outcome was obtained in 41 (89%) patients. Twenty-three (56%) of these 41 had surgical pathology. Twenty-three (56%) had benign lesions and 18 (44%) had malignant/premalignant lesions. Sensitivity, specificity and positive and negative predictive value of EUS alone to distinguish benign from malignant/premalignant pancreatic cystic lesions were 50%, 56%, 36% and 54% and for cytology were 71%, 96%, 92% and 85%, respectively. The corresponding values for the ROC-derived ideal cutoffs were 75%, 90%, 75%, 90% for CA 19-9 (> 37 U/mL) and 70%, 85%, 79% and 78% for CEA (> 3.1 ng/mL). Subgroup analysis of those with surgical pathology yielded almost identical performance and cutoffs.CONCLUSION: Cytology and cyst fluid tumor marker analysis is a very useful tool in distinguishing benign from (pre)malignant pancreatic cystic lesions.

Intraductal Papillary Mucinous Neoplasms of the Pancreas: Performance of Pancreatic Fluid Analysis for Positive Diagnosis and the Prediction of Malignancy

“…These reports often included patients with IPMN. Nevertheless, formal conclusions about the biological profile of IPMN could not be drawn due to several limitations in these studies: the small number of patients studied, a nonoptimal pancreatic fluid sampling, fluid analysis available in only a subgroup of patients, no separate findings of IPMN from other cystic tumors, a nonexhaustive biological analysis (mainly CEA and CA 19.9), and final pathological diagnosis not available for all patients (11,(19)(20)(21)(22). The present study reports the levels of biochemical The first purpose of this study was to describe the levels of each marker in patients with IPMN and to assess their value in the positive diagnosis of IPMN.…”

Impact of endoscopic ultrasound-guided fine-needle aspiration on incidental pancreatic cysts. A prospective study

“…EUS-FNA is a very useful tool in the evaluation of PCs [11]. It provides detailed characteristics of the lesions, including the thickness of the wall, the presence of septae, nodules, and debris, and allows for the sampling of their fluid and solid components [7].…”

“…The fluid, in the presence of >5 cc, was sent for cytopathology evaluation and dosage of Carcinoembryonic antigen (CEA), CA19-9, and amylase levels. The upper limit of normal serum values of CEA and CA19-9 were <5 ng/ml and <37 U/ ml, respectively [10,11]. The upper limit of normal serum values of CEA and CA19-9 were <5 ng/ml and <37 U/ml, respectively.…”

Cystic Lesions of the Pancreas

“…Fluid for analysis can be obtained either radiologically, at laparoscopy, open exploration or increasingly during EUS. Table 1 summarises the data from a range of studies examining the accuracy of fluid analysis in the assessment of pancreatic cysts [62,[70][71][72][73][74][75][76][77][78][79][80][81] . The low cellular content of cyst fluid often hampers cyto- logical analysis except in the differentiation of MCNs where large secretory cells with evidence of mucin secretion may be seen [81] .…”