title: Combination of cyst fluid CEA and CA 125 is an accurate diagnostic tool for differentiating mucinous cystic neoplasms from intraductal papillary mucinous neoplasms.
abstract: OBJECTIVE
  Despite advances in imaging techniques, diagnosis and management of pancreatic cystic lesions still remains challenging. The objective of this study was to determine the utility of cyst fluid analysis (CEA, CA 19-9, CA 125, amylase, and cytology) in categorizing pancreatic cystic lesions, and in differentiating malignant from benign cystic lesions.
  
  
  METHODS
  A retrospective analysis of 68 patients with histologically and clinically confirmed cystic lesions was performed. Cyst fluid was obtained by surgical resection (n = 45) or endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) (n = 23). Cyst fluid tumor markers and amylase were measured and compared between the cyst types.
  
  
  RESULTS
  Receiver operating characteristic (ROC) curve analysis of the tumor markers demonstrated that cyst fluid CEA provided the greatest area under ROC curve (AUC) (0.884) for differentiating mucinous versus non-mucinous cystic lesions. When a CEA cutoff value was set at 67.3 ng/ml, the sensitivity, specificity and accuracy for diagnosing mucinous cysts were 89.2%, 77.8%, and 84.4%, respectively. The combination of cyst fluid CEA content >67.3 ng/ml and cyst fluid CA 125 content >10.0 U/ml segregated 77.8% (14/18) of mucinous cystic neoplasms (MCNs) from other cyst subtypes. On the other hand, no fluid marker was useful for differentiating malignant versus benign cystic lesions. Although cytology (accuracy 83.3%) more accurately diagnosed malignant cysts than CEA (accuracy 65.6%), it lacked sensitivity (35.3%).
  
  
  CONCLUSIONS
  Our results demonstrate that cyst fluid CEA can be a helpful marker in differentiating mucinous from non-mucinous, but not malignant from benign cystic lesions. A combined CEA and CA 125 approach may help segregate MCNs from IPMNs.
authors.affiliation: Department of Gasroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.
authors.forename: Yoshikuni
authors.initials: Y
authors.lastname: Nagashio
authors.affiliation: Department of Gasroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Hijioka
authors.affiliation: Department of Gasroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.
authors.forename: Nobumasa
authors.initials: N
authors.lastname: Mizuno
authors.affiliation: Department of Gasroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hara
authors.affiliation: Department of Gasroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imaoka
authors.affiliation: Department of Medical Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi 110070, India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Bhatia
authors.affiliation: Department of Endoscopy, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Niwa
authors.affiliation: Department of Endoscopy, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tajika
authors.affiliation: Department of Endoscopy, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Department of Endoscopy, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Ishihara
authors.affiliation: Department of Gastrointestinal Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shimizu
authors.affiliation: Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.
authors.forename: Waki
authors.initials: W
authors.lastname: Hosoda
authors.affiliation: Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yatabe
authors.affiliation: Department of Gasroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan. Electronic address: kyamao@aichi-cc.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yamao
mesh_terms: D000681:Amylases / Q000032:analysis; D014408:Biomarkers, Tumor / Q000032:analysis; D018394:CA-125 Antigen / Q000032:analysis*; D002272:Carcinoembryonic Antigen / Q000032:analysis*; D002291:Carcinoma, Papillary / Q000175:diagnosis* / Q000378:metabolism; D020420:Cyst Fluid / Q000737:chemistry* / Q000166:cytology; D006801:Humans; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000378:metabolism; D011237:Predictive Value of Tests; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D002272:Carcinoembryonic Antigen; D000681:Amylases
keywords: Carbohydrate antigen 125 (CA 125); Carcinoembryonic antigen (CEA); Cyst fluid analysis; Cytology; Mucinous cystic lesions; Mucinous cystic neoplasm (MCN)