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Cyst fluid carcinoembryonic antigen level is not predictive of invasive cancer in patients with intraductal papillary mucinous neoplasm of the pancreas.
JOP. 2012 Jul 10; 13(4):409-13.JOP

Abstract

CONTEXT

Cyst fluid CEA concentration>192 ng/mL has proven accurate to differentiate mucinous from non-mucinous pancreatic cystic neoplasms. It is unclear whether the degree of cyst fluid CEA elevation is predictive of malignant behavior in IPMNs.

OBJECTIVES

To determine whether elevated cyst fluid CEA concentrations were predictive of invasive cancer.

DESIGN

Cross sectional study.

SETTING

Single National Cancer Institute comprehensive cancer care center experience.

PATIENTS

47 patients underwent preoperative EUS-FNA with cyst fluid analysis and surgical resection of an IPMN over a 9 year period.

MAIN OUTCOME MEASUREMENTS

Cyst fluid CEA concentrations among the four grades associated with IPMN (low grade dysplasia, moderate dysplasia, high grade dysplasia, and invasive cancer).

RESULTS

The mean±standard deviation cyst fluid CEA concentration increased as the pathology progressed from low grade dysplasia (1,261±1,679 ng/mL) to moderate dysplasia (7,171±22,210 ng/mL) to high grade dysplasia (10,807±36,203 ng/mL). However, the mean CEA level decreased (462±631 ng/mL) once invasive cancer developed (P=0.869). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of a cyst fluid CEA concentration greater than 200 ng/mL for the diagnosis of malignant IPMN (cases of high grade dysplasia and invasive IPMN) was 52.4%, 42.3%, 42.3%, 52.4% and 46.8%, respectively.

LIMITATIONS

Single center experience, small patient numbers, retrospective data collection.

CONCLUSION

The degree of cyst fluid CEA elevation is a poor predictor of malignant degeneration within IPMNs. Clinical management decisions regarding surgical resection should not be based upon degree of cyst fluid CEA elevation.

Authors+Show Affiliations

University of Cincinnati, Cincinnati, OH 45267, USA. stephen.kucera@uc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22797397

Citation

Kucera, Stephen, et al. "Cyst Fluid Carcinoembryonic Antigen Level Is Not Predictive of Invasive Cancer in Patients With Intraductal Papillary Mucinous Neoplasm of the Pancreas." JOP : Journal of the Pancreas, vol. 13, no. 4, 2012, pp. 409-13.
Kucera S, Centeno BA, Springett G, et al. Cyst fluid carcinoembryonic antigen level is not predictive of invasive cancer in patients with intraductal papillary mucinous neoplasm of the pancreas. JOP. 2012;13(4):409-13.
Kucera, S., Centeno, B. A., Springett, G., Malafa, M. P., Chen, Y. A., Weber, J., & Klapman, J. (2012). Cyst fluid carcinoembryonic antigen level is not predictive of invasive cancer in patients with intraductal papillary mucinous neoplasm of the pancreas. JOP : Journal of the Pancreas, 13(4), 409-13. https://doi.org/10.6092/1590-8577/664
Kucera S, et al. Cyst Fluid Carcinoembryonic Antigen Level Is Not Predictive of Invasive Cancer in Patients With Intraductal Papillary Mucinous Neoplasm of the Pancreas. JOP. 2012 Jul 10;13(4):409-13. PubMed PMID: 22797397.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cyst fluid carcinoembryonic antigen level is not predictive of invasive cancer in patients with intraductal papillary mucinous neoplasm of the pancreas. AU - Kucera,Stephen, AU - Centeno,Barbara A, AU - Springett,Gregory, AU - Malafa,Mokenge P, AU - Chen,Yian Ann, AU - Weber,Jill, AU - Klapman,Jason, Y1 - 2012/07/10/ PY - 2012/7/17/entrez PY - 2012/7/17/pubmed PY - 2012/12/10/medline SP - 409 EP - 13 JF - JOP : Journal of the pancreas JO - JOP VL - 13 IS - 4 N2 - CONTEXT: Cyst fluid CEA concentration>192 ng/mL has proven accurate to differentiate mucinous from non-mucinous pancreatic cystic neoplasms. It is unclear whether the degree of cyst fluid CEA elevation is predictive of malignant behavior in IPMNs. OBJECTIVES: To determine whether elevated cyst fluid CEA concentrations were predictive of invasive cancer. DESIGN: Cross sectional study. SETTING: Single National Cancer Institute comprehensive cancer care center experience. PATIENTS: 47 patients underwent preoperative EUS-FNA with cyst fluid analysis and surgical resection of an IPMN over a 9 year period. MAIN OUTCOME MEASUREMENTS: Cyst fluid CEA concentrations among the four grades associated with IPMN (low grade dysplasia, moderate dysplasia, high grade dysplasia, and invasive cancer). RESULTS: The mean±standard deviation cyst fluid CEA concentration increased as the pathology progressed from low grade dysplasia (1,261±1,679 ng/mL) to moderate dysplasia (7,171±22,210 ng/mL) to high grade dysplasia (10,807±36,203 ng/mL). However, the mean CEA level decreased (462±631 ng/mL) once invasive cancer developed (P=0.869). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of a cyst fluid CEA concentration greater than 200 ng/mL for the diagnosis of malignant IPMN (cases of high grade dysplasia and invasive IPMN) was 52.4%, 42.3%, 42.3%, 52.4% and 46.8%, respectively. LIMITATIONS: Single center experience, small patient numbers, retrospective data collection. CONCLUSION: The degree of cyst fluid CEA elevation is a poor predictor of malignant degeneration within IPMNs. Clinical management decisions regarding surgical resection should not be based upon degree of cyst fluid CEA elevation. SN - 1590-8577 UR - https://www.unboundmedicine.com/medline/citation/22797397/Cyst_fluid_carcinoembryonic_antigen_level_is_not_predictive_of_invasive_cancer_in_patients_with_intraductal_papillary_mucinous_neoplasm_of_the_pancreas_ L2 - http://www.serena.unina.it/index.php/jop/article/view/664/991 DB - PRIME DP - Unbound Medicine ER -