title: Preoperative cyst fluid analysis is useful for the differential diagnosis of cystic lesions of the pancreas.
abstract: OBJECTIVE
  It has been suggested that activity of pancreatic enzymes and concentrations of tumoral markers in cyst fluid may help to distinguish pseudocyst, serous, and mucinous cystadenomas. The aim of this study was to prospectively assess the reliability of preoperative biochemical and tumor marker analysis in cyst fluids obtained by fine-needle aspiration for pathological diagnosis.
  
  
  METHODS
  Cyst fluid was obtained preoperatively by fine-needle aspiration, and biochemical and tumoral marker values were measured. The diagnosis of cystic tumors (7 serous cystadenomas and 12 mucinous tumors) was established by surgical specimen analysis. Thirty-one pancreatic pseudocysts complicating well-documented chronic pancreatitis were also studied.
  
  
  RESULTS
  Carbohydrate antigen 19.9 levels of > 50,000 U/mL had a 75% sensitivity and a 90% specificity for distinguishing mucinous tumors from other cystic lesions. Carcinoembryonic antigen levels of < 5 ng/mL had a 100% sensitivity and an 86% specificity for distinguishing serous cystadenomas from other cystic lesions. Amylase levels of > 5000 U/mL had a 94% sensitivity and a 74% specificity for distinguishing pseudocysts from other cystic lesions.
  
  
  CONCLUSIONS
  High carbohydrate antigen 19.9, low carcinoembryonic antigen, and high amylase levels in cyst fluid are very indicative of mucinous tumors, serous cystadenomas, and pseudocysts, respectively.
authors.affiliation: Service de Gastroentérologie, Hôpital Beaujon, Clichy, France.
authors.forename: P
authors.initials: P
authors.lastname: Hammel
authors.forename: P
authors.initials: P
authors.lastname: Levy
authors.forename: H
authors.initials: H
authors.lastname: Voitot
authors.forename: M
authors.initials: M
authors.lastname: Levy
authors.forename: V
authors.initials: V
authors.lastname: Vilgrain
authors.forename: M
authors.initials: M
authors.lastname: Zins
authors.forename: J F
authors.initials: JF
authors.lastname: Flejou
authors.forename: G
authors.initials: G
authors.lastname: Molas
authors.forename: P
authors.initials: P
authors.lastname: Ruszniewski
authors.forename: P
authors.initials: P
authors.lastname: Bernades
mesh_terms: D000681:Amylases / Q000032:analysis; D014408:Biomarkers, Tumor / Q000032:analysis; D001707:Biopsy, Needle; D001826:Body Fluids / Q000737:chemistry* / Q000276:immunology; D018395:CA-19-9 Antigen / Q000032:analysis; D002272:Carcinoembryonic Antigen / Q000032:analysis; D018291:Cystadenoma, Mucinous / Q000737:chemistry / Q000175:diagnosis / Q000276:immunology; D018293:Cystadenoma, Serous / Q000737:chemistry / Q000175:diagnosis / Q000276:immunology; D003937:Diagnosis, Differential; D005240:Feasibility Studies; D006801:Humans; D008049:Lipase / Q000032:analysis; D010181:Pancreatic Cyst / Q000175:diagnosis* / Q000276:immunology / Q000378:metabolism; D010190:Pancreatic Neoplasms / Q000737:chemistry / Q000175:diagnosis* / Q000276:immunology; D010192:Pancreatic Pseudocyst / Q000737:chemistry / Q000175:diagnosis / Q000276:immunology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; D008049:Lipase; D000681:Amylases