Values of carcinoembryonic antigen, elastase 1, and carbohydrate antigen determinant in aspirated pancreatic cystic fluid in the diagnosis of cysts of the pancreas

Abstract

The levels of carcinoembryonic antigen (CEA), elastase 1, and carbohydrate antigen determinant (CA 19-9) in the pancreatic cystic fluid and the serum from five patients with cystadenocarcinoma of the pancreas, one patient with retention cyst due to pancreatic carcinoma, three patients with cystadenoma, and eight patients with benign pseudocyst accompanying or following pancreatitis, were determined by immunoassay technique. Fluid from pancreatic cysts was obtained by ultrasonically-guided percutaneous fine-needle aspiration biopsy. The specimens were centrifuged and the supernatant was used for the measurement of CEA, elastase 1, and CA 19-9, while the cell pellet was examined cytologically. The levels of CEA in the aspirated fluid were significantly higher in patients with malignant cysts of the pancreas than in those with benign cystadenomas and pseudocysts. In contrast, the levels of elastase 1 were significantly lower in patients with malignant cysts than in those with benign pancreatic cysts. Although the levels of CA 19-9 were significantly higher in patients with malignant cysts than in those with pseudocysts, the overlap between the values of patients with malignant and benign pancreatic cysts is too great. The serum CA 19-9 was most useful, however, to distinguish an individual patient with malignant cysts of the pancreas from those with benign pancreatic cyst, since there were no significant differences between the levels of serum CEA and elastase 1 in patients with malignant and benign pancreatic cysts. Correct diagnoses were made cytologically in 4 (66.7%) of 6 patients with malignant cysts. In two patients with malignant cyst, in whom no cancer cells were detectable in the aspirated materials, levels of CEA were abnormally high, but high levels of elastase 1 did not occur. Therefore, the combined measurement of CEA and elastase 1 in the aspirated cystic fluid of the pancreas could be used as an aid in diagnosis of malignant cysts of the pancreas.

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

“…17 Subsequent studies showed that CEA levels were elevated in the pancreatic cyst fluid. 18,19 In 2004, a multicenter, blinded study by Brugge et al 20 showed that, at an optimal cutoff of 192 ng/mL, cyst fluid CEA levels were capable of differentiating an MCN from an NMCN with a high degree of accuracy (sensitivity of 73%, specificity of 84%). 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%).…”

True Solitary Pancreatic Cyst in an Adult: Report of a Case

“…[1][2][3][4][5][6][7][8] Cytological analysis can provide much useful preoperative information to help in the diagnosis of cystic neoformations, based on levels of pancreatic enzymes, and tumoral markers (CEA, CA 19-9) in cystic fluid obtained by fine-needle cytology. [23][24][25][26][27] Only the case reported by Nigaard and Stacy 2 described an elevated concentration of pancreatic enzymes in cystic liquid. In ten patients this concentration was comparable to that of the serum levels.…”

The Role of Bile Carcinoembryonic Antigen in Diagnosing Bile Duct Cancer

“…This antigen has been detected in various body fluids such as the gastrointestinal and pancreatobiliary juice (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Several studies have described the diagnostic utility of the increased CEA levels in the body fluids in primary malignant tumors arising from the stomach, colon, biliary tract, and pancreas (4-11).…”

“…Currently, the performance of the available tumor markers as screening tests for diagnosing a malignancy in high risk individuals is inadequate because of the reduced sensitivity and occasional false-positive results (1)(2)(3). However, several studies have suggested that measuring the CEA in the body fluid bathing primary or metastatic tumors may be more useful than the serum value (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). The aim of this study was to determine the diagnostic role of the bile CEA levels in patients with bile duct cancer.…”