A Lower Cyst Fluid CEA Cut-Off Increases Diagnostic Accuracy in Identifying Mucinous Pancreatic Cystic Lesions

摘要

Context Carcinoembryonicantigen analysis of pancreatic cyst fluid is the tumor marker of choice forpreoperatively differentiating mucinous from non-mucinous cystic lesions. ObjectiveWe aim to determine the most accurate cyst carcinoembryonic antigen cut-offvalue for distinguishing mucinous cysts from non-mucinous cysts with a focus ondiscriminating intraductal papillary mucinous neoplasms. Methods Theresults of pancreatic cyst aspiration carcinoembryonic antigen levels from asingle center were retrospectively collected and evaluated for a diagnosis of amucinous cyst and an assessment of malignancy using surgical histology as thediagnostic standard in 86 patients. Results The median cystcarcinoembryonic antigen level (ng/mL) was significantly higher in mucinouscysts compared with non-mucinous cysts (218 vs. 4.4; P=0.0006) and inintraductal papillary mucinous neoplasms compared with non-mucinous cysts (135 vs.4.4; P=0.0027). A cyst carcinoembryonic antigen cut-off of 30.7 ng/mL was mostaccurate (87.2%) for differentiating mucinous from non-mucinous cysts andspecifically for differentiating intraductal papillary mucinous neoplasms fromnon-mucinous cysts (82.7%). Cyst carcinoembryonic antigen levels were notsignificantly different between malignant and non-malignant mucinous cysts(68.5 vs. 238.1; P=0.51). Conclusions Pancreatic cyst fluidcarcinoembryonic antigen can accurately differentiate histologically verifiedmucinous lesions, including intraductal papillary mucinous neoplasms, fromnon-mucinous lesions with an optimal cut-off that is much lower than previouslyreported values. Cyst carcinoembryonic antigen levelsare not a reliable predictor of malignancy.