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Suboptimal accuracy of carcinoembryonic antigen in differentiation of mucinous and nonmucinous pancreatic cysts: results of a large multicenter study.
Gastrointest Endosc. 2015 Dec; 82(6):1060-9.GE

Abstract

BACKGROUND AND AIMS

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.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri, USA.Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri, USA.Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri, USA.Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri, USA.Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri, USA.Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri, USA.Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.Division of Gastroenterology, Feinberg School of Medicine Northwestern University, Chicago, Illinois, USA.Division of Gastroenterology, Feinberg School of Medicine Northwestern University, Chicago, Illinois, USA.Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri, USA.Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri, USA.Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA; Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Denver, Colorado, USA.

Pub Type(s)

Evaluation Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

26077458

Citation

Gaddam, Srinivas, et al. "Suboptimal Accuracy of Carcinoembryonic Antigen in Differentiation of Mucinous and Nonmucinous Pancreatic Cysts: Results of a Large Multicenter Study." Gastrointestinal Endoscopy, vol. 82, no. 6, 2015, pp. 1060-9.
Gaddam S, Ge PS, Keach JW, et al. Suboptimal accuracy of carcinoembryonic antigen in differentiation of mucinous and nonmucinous pancreatic cysts: results of a large multicenter study. Gastrointest Endosc. 2015;82(6):1060-9.
Gaddam, S., Ge, P. S., Keach, J. W., Mullady, D., Fukami, N., Edmundowicz, S. A., Azar, R. R., Shah, R. J., Murad, F. M., Kushnir, V. M., Watson, R. R., Ghassemi, K. F., Sedarat, A., Komanduri, S., Jaiyeola, D. M., Brauer, B. C., Yen, R. D., Amateau, S. K., Hosford, L., ... Wani, S. (2015). Suboptimal accuracy of carcinoembryonic antigen in differentiation of mucinous and nonmucinous pancreatic cysts: results of a large multicenter study. Gastrointestinal Endoscopy, 82(6), 1060-9. https://doi.org/10.1016/j.gie.2015.04.040
Gaddam S, et al. Suboptimal Accuracy of Carcinoembryonic Antigen in Differentiation of Mucinous and Nonmucinous Pancreatic Cysts: Results of a Large Multicenter Study. Gastrointest Endosc. 2015;82(6):1060-9. PubMed PMID: 26077458.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Suboptimal accuracy of carcinoembryonic antigen in differentiation of mucinous and nonmucinous pancreatic cysts: results of a large multicenter study. AU - Gaddam,Srinivas, AU - Ge,Phillip S, AU - Keach,Joseph W, AU - Mullady,Daniel, AU - Fukami,Norio, AU - Edmundowicz,Steven A, AU - Azar,Riad R, AU - Shah,Raj J, AU - Murad,Faris M, AU - Kushnir,Vladimir M, AU - Watson,Rabindra R, AU - Ghassemi,Kourosh F, AU - Sedarat,Alireza, AU - Komanduri,Srinadh, AU - Jaiyeola,Diana-Marie, AU - Brauer,Brian C, AU - Yen,Roy D, AU - Amateau,Stuart K, AU - Hosford,Lindsay, AU - Hollander,Thomas, AU - Donahue,Timothy R, AU - Schulick,Richard D, AU - Edil,Barish H, AU - McCarter,Martin, AU - Gajdos,Csaba, AU - Attwell,Augustin, AU - Muthusamy,V Raman, AU - Early,Dayna S, AU - Wani,Sachin, Y1 - 2015/06/12/ PY - 2015/01/30/received PY - 2015/04/26/accepted PY - 2015/6/17/entrez PY - 2015/6/17/pubmed PY - 2016/9/13/medline SP - 1060 EP - 9 JF - Gastrointestinal endoscopy JO - Gastrointest Endosc VL - 82 IS - 6 N2 - BACKGROUND AND AIMS: 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. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/26077458/Suboptimal_accuracy_of_carcinoembryonic_antigen_in_differentiation_of_mucinous_and_nonmucinous_pancreatic_cysts:_results_of_a_large_multicenter_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(15)02400-1 DB - PRIME DP - Unbound Medicine ER -