title: Suboptimal accuracy of carcinoembryonic antigen in differentiation of mucinous and nonmucinous pancreatic cysts: results of a large multicenter study.
abstract: OBJECTIVE
  The exact cutoff value at which pancreatic cyst fluid carcinoembryonic antigen (CEA) level distinguishes pancreatic mucinous cystic neoplasms (MCNs) from pancreatic nonmucinous cystic neoplasms (NMCNs) is unclear. The aim of this multicenter retrospective study was to evaluate the diagnostic accuracy of cyst fluid CEA levels in differentiating between MCNs and NMCNs.
  
  
  METHODS
  Consecutive patients who underwent EUS with FNA at 3 tertiary care centers were identified. Patients with histologic confirmation of cyst type based on surgical specimens served as the criterion standard for this analysis. Demographic characteristics, EUS morphology, FNA fluid, and cytology results were recorded. Multivariate logistic regression analysis to identify predictors of MCNs was performed. Receiver-operating characteristic (ROC) curves were generated for CEA levels.
  
  
  RESULTS
  A total of 226 patients underwent surgery (mean age, 61 years, 96% white patients, 39% female patients) of whom 88% underwent Whipple's procedure or distal pancreatectomy. Based on surgical histopathology, there were 150 MCNs and 76 NMCNs cases. The median CEA level was 165 ng/mL. The area under the ROC curve for CEA levels in differentiating between MCNs and NMCNs was 0.77 (95% confidence interval, 0.71-0.84, P < .01) with a cutoff of 105 ng/mL, demonstrating a sensitivity and specificity of 70% and 63%, respectively. The cutoff value of 192 ng/mL yielded a sensitivity of 61% and a specificity of 77% and would misdiagnose 39% of MCN cases.
  
  
  CONCLUSIONS
  Cyst fluid CEA levels have a clinically suboptimal accuracy level in differentiating MCNs from NMCNs. Future studies should focus on novel cyst fluid markers to improve risk stratification of pancreatic cystic neoplasms.
authors.affiliation: Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Gaddam
authors.affiliation: Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Phillip S
authors.initials: PS
authors.lastname: Ge
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Keach
authors.affiliation: Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Mullady
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.
authors.forename: Norio
authors.initials: N
authors.lastname: Fukami
authors.affiliation: Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Edmundowicz
authors.affiliation: Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Riad R
authors.initials: RR
authors.lastname: Azar
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.
authors.forename: Raj J
authors.initials: RJ
authors.lastname: Shah
authors.affiliation: Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Faris M
authors.initials: FM
authors.lastname: Murad
authors.affiliation: Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Vladimir M
authors.initials: VM
authors.lastname: Kushnir
authors.affiliation: Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Rabindra R
authors.initials: RR
authors.lastname: Watson
authors.affiliation: Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Kourosh F
authors.initials: KF
authors.lastname: Ghassemi
authors.affiliation: Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Alireza
authors.initials: A
authors.lastname: Sedarat
authors.affiliation: Division of Gastroenterology, Feinberg School of Medicine Northwestern University, Chicago, Illinois, USA.
authors.forename: Srinadh
authors.initials: S
authors.lastname: Komanduri
authors.affiliation: Division of Gastroenterology, Feinberg School of Medicine Northwestern University, Chicago, Illinois, USA.
authors.forename: Diana-Marie
authors.initials: DM
authors.lastname: Jaiyeola
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Brauer
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.
authors.forename: Roy D
authors.initials: RD
authors.lastname: Yen
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.
authors.forename: Stuart K
authors.initials: SK
authors.lastname: Amateau
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Hosford
authors.affiliation: Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hollander
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Donahue
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.
authors.forename: Barish H
authors.initials: BH
authors.lastname: Edil
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: McCarter
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.
authors.forename: Csaba
authors.initials: C
authors.lastname: Gajdos
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA.
authors.forename: Augustin
authors.initials: A
authors.lastname: Attwell
authors.affiliation: Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: V Raman
authors.initials: VR
authors.lastname: Muthusamy
authors.affiliation: Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Dayna S
authors.initials: DS
authors.lastname: Early
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Centennial, Colorado, USA; Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Denver, Colorado, USA.
authors.forename: Sachin
authors.initials: S
authors.lastname: Wani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002272:Carcinoembryonic Antigen / Q000378:metabolism*; D018282:Cystadenocarcinoma, Mucinous / Q000175:diagnosis* / Q000378:metabolism; D018291:Cystadenoma, Mucinous / Q000175:diagnosis* / Q000378:metabolism; D003937:Diagnosis, Differential; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000378:metabolism; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D002272:Carcinoembryonic Antigen