Suboptimal accuracy of carcinoembryonic antigen in differentiation of mucinous and nonmucinous pancreatic cysts: results of a large multicenter study

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• 作者：Srinivas Gaddam ; MD^&lowast ; ; ¹ ; Phillip S. Ge ; MD^&lowast ; ; ³ ; Joseph W. Keach ; MD² ; Daniel Mullady ; MD¹ ; Norio Fukami ; MD² ; Steven A. Edmundowicz ; MD¹ ; Riad R. Azar ; MD¹ ; Raj J. Shah ; MD² ; Faris M. Murad ; MD¹ ; Vladimir M. Kushnir ; MD¹ ; Rabindra R. Watson ; MD³ ; Kourosh F. Ghassemi ; MD³ ; Alireza Sedarat ; MD³ ; Srinadh Komanduri ; MD⁴ ; Diana-Marie Jaiyeola ; MD⁴ ; Brian C. Brauer ; MD² ; Roy D. Yen ; MD ; MPH² ; Stuart K. Amateau ; MD ; PhD² ; Lindsay Hosford ; BS² ; Thomas Hollander ; MS¹ ; Timothy R. Donahue ; MD⁵ ; Richard D. Schulick ; MD² ; Barish H. Edil ; MD² ; Martin McCarter ; MD² ; Csaba Gajdos ; MD² ; Augustin Attwell ; MD² ; V. Raman Muthusamy ; MD³ ; Dayna S. Early ; MD¹ ; Sachin Wani ; MD² ; ⁶ ;
• 关键词：AUC ; area under curve ; CEA ; carcinoembryonic antigen ; IPMN ; intraductal papillary mucinous neoplasm ; IQR ; interquartile range ; MCN ; mucinous cystic neoplasm ; NMCN ; nonmucinous cystic neoplasm ; ROC ; receiver-operating characteristic ; SD ; standard deviation
• 刊名：Gastrointestinal Endoscopy
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：82
• 期：6
• 页码：1060-1069
• 全文大小：562 K

文摘

The exact cutoff value at which pancreatic cyst fluid carcinoembryonic antigen (CEA) level distinguishes pancreatic mucinous cystic neoplasms (MCNs) from pancreatic nonmucinous cystic neoplasms (NMCNs) is unclear. The aim of this multicenter retrospective study was to evaluate the diagnostic accuracy of cyst fluid CEA levels in differentiating between MCNs and NMCNs.

Methods

Consecutive patients who underwent EUS with FNA at 3 tertiary care centers were identified. Patients with histologic confirmation of cyst type based on surgical specimens served as the criterion standard for this analysis. Demographic characteristics, EUS morphology, FNA fluid, and cytology results were recorded. Multivariate logistic regression analysis to identify predictors of MCNs was performed. Receiver-operating characteristic (ROC) curves were generated for CEA levels.

Results

A total of 226 patients underwent surgery (mean age, 61 years, 96% white patients, 39% female patients) of whom 88% underwent Whipple’s procedure or distal pancreatectomy. Based on surgical histopathology, there were 150 MCNs and 76 NMCNs cases. The median CEA level was 165 ng/mL. The area under the ROC curve for CEA levels in differentiating between MCNs and NMCNs was 0.77 (95% confidence interval, 0.71–0.84, P < .01) with a cutoff of 105 ng/mL, demonstrating a sensitivity and specificity of 70% and 63%, respectively. The cutoff value of 192 ng/mL yielded a sensitivity of 61% and a specificity of 77% and would misdiagnose 39% of MCN cases.

Conclusions

Cyst fluid CEA levels have a clinically suboptimal accuracy level in differentiating MCNs from NMCNs. Future studies should focus on novel cyst fluid markers to improve risk stratification of pancreatic cystic neoplasms.