Serum tumor markers and cyst fluid analysis are useful for the diagnosis of pancreatic cystic tumors.
BACKGROUND
This study was performed to evaluate the utility of serum and cyst fluid analysis for enzymes (amylase and lipase) and tumor markers (carcinoembryonic antigen, CA 19-9, CA 125, and CA 72-4) in the differential diagnosis of cystic pancreatic lesions.


METHODS
Serum and cyst fluid were obtained from 48 patients with pancreatic cysts (21 pseudocysts, 14 mucinous cystic neoplasms, 6 ductal carcinomas, and 7 serous cystadenomas), observed between 1989 and 1994.


RESULTS
Serum CA 19-9 levels were significantly higher in ductal carcinomas (all > 100 U/mL) and mucinous cystic neoplasms (P < 0.05). CA 72-4 cyst fluid levels were significantly higher in mucinous cystic tumors (P < 0.005), with 95% specificity and 80% sensitivity in detecting mucinous or malignant cysts. A combined assay of serum CA 19-9 and cyst fluid CA 72-4 correctly identified 19 of 20 (pre-) malignant lesions (95%), with only 1 false-positive result (3.6%). Cytology showed a sensitivity of 48% and specificity of 100%.


CONCLUSIONS
Any pancreatic cyst with high serum CA 19-9 values, positive cytology, or high CA 72-4 in the fluid should be considered for resection.
Sperti
C
C
Department of Surgery, University of Padua, Italy.
Pasquali
C
C
Guolo
P
P
Polverosi
R
R
Liessi
G
G
Pedrazzoli
S
S
D000230:Adenocarcinoma / Q000097:blood / Q000378:metabolism; D000681:Amylases / Q000032:analysis / Q000097:blood; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000032:analysis / Q000097:blood; D014408:Biomarkers, Tumor / Q000032:analysis / Q000097:blood*; D018394:CA-125 Antigen / Q000032:analysis / Q000097:blood; D018395:CA-19-9 Antigen / Q000032:analysis / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000032:analysis / Q000097:blood; D018282:Cystadenocarcinoma, Mucinous / Q000097:blood / Q000378:metabolism; D018291:Cystadenoma, Mucinous / Q000097:blood / Q000378:metabolism; D018293:Cystadenoma, Serous / Q000097:blood / Q000378:metabolism; D003937:Diagnosis, Differential; D005122:Exudates and Transudates / Q000737:chemistry / Q000201:enzymology; D005260:Female; D006801:Humans; D008049:Lipase / Q000032:analysis / Q000097:blood; D008297:Male; D010181:Pancreatic Cyst / Q000097:blood / Q000175:diagnosis / Q000378:metabolism*; D010183:Pancreatic Ducts; D010190:Pancreatic Neoplasms / Q000097:blood / Q000175:diagnosis / Q000378:metabolism*; D010192:Pancreatic Pseudocyst / Q000097:blood / Q000378:metabolism; D012680:Sensitivity and Specificity
D015295:Antigens, Tumor-Associated, Carbohydrate; D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D018395:CA-19-9 Antigen; C083825:CA-72-4 antigen; D002272:Carcinoembryonic Antigen; D008049:Lipase; D000681:Amylases