Pancreatic cyst fluid analysis for differential diagnosis between benign and malignant lesions

Abstract

The majority of pancreatic cysts are detected incidentally when abdominal imaging is performed during unrelated procedures. The aim of the present study was to assess the diagnostic utility and clinical value of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9) and amylase analysis in pancreatic cyst fluid. The study included 52 patients with pancreatic cystic lesions, who underwent fine-needle aspiration biopsy to collect cystic fluid for cytological and biochemical analysis. Cysts were classified as benign (simple cysts, pseudocysts and serous cystadenomas) in 36 patients or premalignant/malignant (mucinous cyst-adenomas, intraductal papillary mucinous neoplasm and cystadenocarcinomas) in 16 patients. CEA and CA 19-9 were elevated in patients with malignant cysts (238±12.5 ng/ml and 222±31.5 U/ml, respectively) compared with benign lesions (34.5±3.7 ng/ml and 18.5±1.9 U/ml, respectively; P<0.001). Based on these results, the sensitivity and specificity of CEA were 91.8 and 63.9% and of CA 19-9 were 81.3 and 69.4%, respectively. Mean amylase levels in benign lesions (27825.7±91.9 U/l) were higher compared with malignant pancreatic cysts (8359.2±32.7 U/l; P<0.05). Cyst fluid analysis may prove a safe and useful adjunct for the differential diagnosis of pancreatic cystic lesions. In the present study, promising results for CEA and CA 19-9 have been demonstrated, however, the clinical value of these molecules must be confirmed.

Pancreatic cyst fluid harbors a unique microbiome

“…The cysts were grouped based on the pathological classifications, and they are tested using White’s non parametric t test, two tailed with Benjamini-Hochberg multiple test corrections of P value ( P < 0.05) [ 24 ]. The measured levels of CEA and CA19.9 ranges were used for classification of cysts as cysts, benign cysts, and malignant cysts according to study conducted by Talar-Wojnarowska et al [ 25 ]. Then the classified data was used for the specific bacterial taxa identification between the resected types using the same parameters.…”

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

“…However, subsequent small case series have shown that CEA levels may not be accurate as previously reported (sensitivity of 28%-100%, specificity of 25%-100%). [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] AIM The aim of this study was to evaluate the diagnostic performance characteristics of CEA levels in differentiating pancreatic cystic neoplasms (MCNs vs NMCNs) in a large multicenter cohort of consecutive patients undergoing surgical resection of a suspected pancreatic cystic neoplasm.…”

A prospective study of endoscopic ultrasonography features, cyst fluid carcinoembryonic antigen, and fluid cytology for the differentiation of small pancreatic cystic neoplasms

“…Talar-Wojnarowska et al . [ 4 ] included 52 patients with PCLs and found that CEA was elevated to 238 ± 12.5 ng/mL in patients with malignant cysts. Alkaade et al .…”

“…[ 3 ] The pathological types of pancreatic cystic neoplasms (PCNs) include serous cystic neoplasms (SCNs), mucous cystic neoplasms (MCNs), solid false papilloma neoplasms (SPNs), intraductal papillary mucinous neoplasms (IPMNs), and pancreatic neuroendocrine tumors (PNETs). [ 4 ] PPs, SPNs, PNETs, and SCNs are generally regarded as nonmucinous cystic neoplastic lesions and are benign. MCNs and IPMNs are characterized as mucinous cystic neoplastic lesions, and their malignant potential is represented by an adenoma-carcinoma sequence.…”