Comparison of carcinoembryonic antigen and molecular analysis in pancreatic cyst fluid.
BACKGROUND
Pancreatic-cyst fluid carcinoembryonic antigen (CEA) levels and molecular analysis are useful diagnostic tests in differentiating mucinous from nonmucinous cysts.


OBJECTIVE
To assess agreement between CEA and molecular analysis for differentiating mucinous from nonmucinous cysts.


METHODS
Retrospective analysis.


METHODS
Academic medical center.


METHODS
Patients who underwent EUS-guided FNA for evaluation of pancreatic cysts were identified. The following information was used to designate a cyst mucinous: the CEA criterion was CEA level >or=192 ng/mL and the molecular analysis criteria were DNA quantity >or=40 ng/microL and/or k-ras 2-point mutation and/or >or=2 allelic imbalance mutations. Pathologic analysis of cysts served as the criterion standard.


RESULTS
From 2006 to 2007, 100 patients met the study criteria. The average age of the patients was 63 years, 65% were women, and 30% were symptomatic. The mean diameter of pancreatic cysts was 2.5 cm. The median CEA value was 83 ng/mL (range 1-50,000 ng/mL), the mean DNA content was 16 ng/microL (range 1-212 ng/microL), 11% had K-ras mutations, and 43% had >or=2 allelic imbalance mutations. When using prespecified criteria, there was poor agreement between CEA and molecular analysis for the classification of mucinous cysts (kappa = 0.2). Poor agreement existed between CEA and DNA quantity (Spearman correlation = 0.2; P = .1), K-ras mutation (kappa = 0.3), and >or=2 allelic imbalance mutations (kappa = 0.1). Of the 19 patients for whom a final pathologic diagnosis was available, CEA had a sensitivity of 82% compared with 77% for molecular analysis. When CEA and molecular analysis were combined, 100% sensitivity was achieved.


CONCLUSIONS
Retrospective analysis and small sample size.


CONCLUSIONS
There was poor agreement between CEA levels and molecular analysis for diagnosis of mucinous cysts. Diagnostic sensitivity was improved when results of CEA levels and molecular analysis were combined.
Sawhney
Mandeep S
MS
Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA. msawhney0@bidmc.harvard.edu
Devarajan
Shiva
S
O'Farrel
Paul
P
Cury
Marcelo S
MS
Kundu
Rabi
R
Vollmer
Charles M
CM
Brown
Alphonso
A
Chuttani
Ram
R
Pleskow
Douglas K
DK
D002288:Adenocarcinoma, Mucinous / Q000235:genetics / Q000473:pathology; D000368:Aged; D022981:Allelic Imbalance; D014408:Biomarkers, Tumor / Q000378:metabolism*; D044963:Biopsy, Fine-Needle; D002272:Carcinoembryonic Antigen / Q000378:metabolism*; D021441:Carcinoma, Pancreatic Ductal / Q000235:genetics / Q000473:pathology; D002471:Cell Transformation, Neoplastic / Q000235:genetics / Q000473:pathology; D020420:Cyst Fluid / Q000378:metabolism; D018282:Cystadenocarcinoma, Mucinous / Q000235:genetics / Q000473:pathology; D018291:Cystadenoma, Mucinous / Q000235:genetics / Q000473:pathology; D004273:DNA, Neoplasm / Q000235:genetics*; D003937:Diagnosis, Differential; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology; D010181:Pancreatic Cyst / Q000235:genetics* / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000235:genetics* / Q000473:pathology; D017354:Point Mutation / Q000235:genetics; D011237:Predictive Value of Tests; D011379:Prognosis; D011518:Proto-Oncogene Proteins; D016283:Proto-Oncogene Proteins p21(ras); D012189:Retrospective Studies; D018084:Ultrasonography, Interventional; D018631:ras Proteins
D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D004273:DNA, Neoplasm; C117307:KRAS protein, human; D011518:Proto-Oncogene Proteins; D016283:Proto-Oncogene Proteins p21(ras); D018631:ras Proteins