title: Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study.
abstract: 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.
authors.affiliation: Gastrointestinal Unit, Department of Surgery, Massachusetts General Hospital, Blake 4, 55 Fruit Street, Boston, MA 02114, USA. Wbrugge@partners.org
authors.forename: William R
authors.initials: WR
authors.lastname: Brugge
authors.forename: Kent
authors.initials: K
authors.lastname: Lewandrowski
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lee-Lewandrowski
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Centeno
authors.forename: Tara
authors.initials: T
authors.lastname: Szydlo
authors.forename: Susan
authors.initials: S
authors.lastname: Regan
authors.forename: Carlos Fernandez
authors.initials: CF
authors.lastname: del Castillo
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Warshaw
mesh_terms: 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
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen