title: A comparative analysis of K-ras mutation and carcinoembryonic antigen in pancreatic cyst fluid.
abstract: OBJECTIVE
  Analysis of cystic fluid may be useful in distinguishing between benign and malignant cysts which has significant impact on their management. The aim of our study was to assess the diagnostic utility of carcinoembryonic antigen (CEA) and K-ras gene mutation in pancreatic cysts fluid.
  
  
  METHODS
  The study included 56 patients with pancreatic cystic fluid collected for analysis. The cysts were classified as benign (simple cysts, pseudocysts, serous cystadenoma) - 39 patients or premalignant/malignant (mucinous cystadenoma, IPMN, cystadenocarcinoma) - 17 patients. The patients history, CEA fluid concentrations and presence of K-ras mutation were analyzed.
  
  
  RESULTS
  CEA were higher in patients with malignant cysts (mean levels 238 ± 12.5 ng/ml; range 32.8-4985 ng/ml) compared to benign lesions (mean levels 34.5 ± 3.7 ng/ml; range 3.9-693 ng/ml; p < 0.001). K-ras mutation correctly classified 11 of 17 patients with premalignant/malignant lesions. It was also detected in 1 patient with final diagnosis of benign cyst (the sensitivity 64.7% and the specificity 97.4%; p < 0.01). If CEA and molecular analysis were combined in that cysts with either CEA level>45 ng/ml or presence of K-ras mutation, than 16 of 17 premalignant/malignant cysts were correctly identified (94.1%).
  
  
  CONCLUSIONS
  Molecular analysis of pancreatic cyst fluid adds diagnostic value to the preoperative diagnosis and should be considered when cyst cytologic examination is negative for malignancy.
authors.affiliation: Department of Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland. r-wojnarowska@wp.pl
authors.forename: Renata
authors.initials: R
authors.lastname: Talar-Wojnarowska
authors.forename: Marek
authors.initials: M
authors.lastname: Pazurek
authors.forename: Lukasz
authors.initials: L
authors.lastname: Durko
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Degowska
authors.forename: Grazyna
authors.initials: G
authors.lastname: Rydzewska
authors.forename: Jacek
authors.initials: J
authors.lastname: Smigielski
authors.forename: Adam
authors.initials: A
authors.lastname: Janiak
authors.forename: Marek
authors.initials: M
authors.lastname: Olakowski
authors.forename: Pawel
authors.initials: P
authors.lastname: Lampe
authors.forename: Piotr
authors.initials: P
authors.lastname: Grzelak
authors.forename: Ludomir
authors.initials: L
authors.lastname: Stefanczyk
authors.forename: Beata
authors.initials: B
authors.lastname: Smolarz
authors.forename: Ewa
authors.initials: E
authors.lastname: Malecka-Panas
mesh_terms: D000328:Adult; D000368:Aged; D002272:Carcinoembryonic Antigen / Q000032:analysis; D020420:Cyst Fluid / Q000737:chemistry*; D003536:Cystadenocarcinoma / Q000235:genetics; D018282:Cystadenocarcinoma, Mucinous / Q000235:genetics; D018291:Cystadenoma, Mucinous / Q000235:genetics; D018293:Cystadenoma, Serous / Q000235:genetics; D005260:Female; D011905:Genes, ras / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000737:chemistry; D010181:Pancreatic Cyst / Q000235:genetics*; D010190:Pancreatic Neoplasms / Q000235:genetics; D010192:Pancreatic Pseudocyst / Q000235:genetics; D011230:Precancerous Conditions / Q000235:genetics
chemical_list: D002272:Carcinoembryonic Antigen