title: Cyst carcinoembryonic antigen in differentiating pancreatic cysts: a meta-analysis.
abstract: BACKGROUND
  Using carcinoembryonic antigen in discriminating between benign and malignant disease remains controversial.
  
  
  OBJECTIVE
  We aim to evaluate the diagnostic accuracy of cyst fluid carcinoembryonic antigen in predicting malignant pancreatic cystic lesions.
  
  
  METHODS
  We performed a literature search of MEDLINE and EMBASE. We included studies that compared the diagnostic accuracy of carcinoembryonic antigen with histology. Pooled estimates of diagnostic precision were calculated using random-effects models.
  
  
  RESULTS
  Eight studies (504 patients) were included. The carcinoembryonic antigen cutoff level for determining a malignant cyst ranged from 109.9 to 6000 ng/mL. Pooled estimates of carcinoembryonic antigen in malignant cysts prediction were poor: pooled sensitivity of 63%, pooled specificity of 63%. The positive likelihood ratio was 1.89 and the negative likelihood ratio was 0.62. The diagnostic odds ratio was 3.84. The area under the summary receiver-operating characteristic curve was 0.70. In subgroup analysis of patients with mucinous cysts (mucinous cystic neoplasm and intraductal papillary mucinous neoplasm; 5 studies, 227 patients), pooled sensitivity was 65%, pooled specificity 66% and diagnostic odds ratio 4.74 respectively.
  
  
  CONCLUSIONS
  This meta-analysis suggests that the accuracy of carcinoembryonic antigen in differentiating "between benign and malignant" pancreatic cysts was poor. The decision to perform surgical resection for pancreatic cystic lesions should not be based solely on carcinoembryonic antigen level.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA.
authors.forename: Saowanee
authors.initials: S
authors.lastname: Ngamruengphong
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bartel
authors.forename: Massimo
authors.initials: M
authors.lastname: Raimondo
mesh_terms: D044963:Biopsy, Fine-Needle; D002272:Carcinoembryonic Antigen / Q000032:analysis*; D020420:Cyst Fluid / Q000737:chemistry; D003937:Diagnosis, Differential; D006801:Humans; D010181:Pancreatic Cyst / Q000175:diagnosis* / Q000378:metabolism
chemical_list: D002272:Carcinoembryonic Antigen
keywords: Endoscopic ultrasonography; Fine-needle aspiration; Pancreatic cancer