Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study.
OBJECTIVE
Cysts of the pancreas display a wide spectrum of histology, including inflammatory (pseudocysts), benign (serous), premalignant (mucinous), and malignant (mucinous) lesions. Endoscopic ultrasonography (EUS) may offer a diagnostic tool through the combination of imaging and guided, fine-needle aspiration (FNA). The purpose of this investigation was to determine the most accurate test for differentiating mucinous from nonmucinous cystic lesions.


METHODS
The results of EUS imaging, cyst fluid cytology, and cyst fluid tumor markers (CEA, CA 72-4, CA 125, CA 19-9, and CA 15-3) were prospectively collected and compared in a multicenter study using histology as the final diagnostic standard.


RESULTS
Three hundred forty-one (341) patients underwent EUS and FNA of a pancreatic cystic lesion; 112 of these patients underwent surgical resection, providing a histologic diagnosis of the cystic lesion (68 mucinous, 7 serous, 27 inflammatory, 5 endocrine, and 5 other). Receiver operator curve analysis of the tumor markers demonstrated that cyst fluid CEA (optimal cutoff of 192 ng/mL) demonstrated the greatest area under the curve (0.79) for differentiating mucinous vs. nonmucinous cystic lesions. The accuracy of CEA (88 of 111, 79%) was significantly greater than the accuracy of EUS morphology (57 of 112, 51%) or cytology (64 of 109, 59%) (P < 0.05). There was no combination of tests that provided greater accuracy than CEA alone (P < 0.0001).


CONCLUSIONS
Of tested markers, cyst fluid CEA is the most accurate test available for the diagnosis of mucinous cystic lesions of the pancreas.
Brugge
William R
WR
Gastrointestinal Unit, Department of Surgery, Massachusetts General Hospital, Blake 4, 55 Fruit Street, Boston, MA 02114, USA. Wbrugge@partners.org
Lewandrowski
Kent
K
Lee-Lewandrowski
Elizabeth
E
Centeno
Barbara A
BA
Szydlo
Tara
T
Regan
Susan
S
del Castillo
Carlos Fernandez
CF
Warshaw
Andrew L
AL
D014408:Biomarkers, Tumor / Q000032:analysis; D001826:Body Fluids / Q000737:chemistry; D002272:Carcinoembryonic Antigen / Q000032:analysis; D019160:Endosonography; D006801:Humans; D008875:Middle Aged; D010181:Pancreatic Cyst / Q000737:chemistry / Q000175:diagnosis* / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000737:chemistry / Q000175:diagnosis* / Q000473:pathology
D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen