title: Diagnostic Accuracy of Endoscopic Ultrasound-Guided Fine-Needle Aspiration Cytology, Carcinoembryonic Antigen, and Amylase in Intraductal Papillary Mucinous Neoplasm.
abstract: The aim of this study was to determine the accuracy of cytology, carcinoembryonic antigen (CEA), and amylase levels in the preoperative diagnosis of intraductal papillary mucinous neoplasms (IPMNs).
  
  
  
  An international registry was started in 2005 and included patients with clinically suspected IPMNs. Those who underwent surgery and had preoperative endoscopic ultrasonography fine-needle aspiration were selected for the study.
  
  
  
  One hundred eighty patients were included. Cytological analysis for neoplastic cells in IPMNs showed high specificity (87.8%) but low sensitivity (39.4%). The median CEA level was 525.5 ng/mL (n = 78) in IPMNs versus 9.7 ng/mL in nonmucinous cysts (n = 6), showing an area under the receiver operating characteristic curve (AUC) of 0.87. The optimal cutoff CEA value for distinguishing IPMN from nonmucinous cysts was 129 ng/mL. At this level, the sensitivity was 76.9%, and specificity was 83.3%, yielding a positive predictive value of 95.9% and a negative predictive value of 41.9%. Carcinoembryonic antigen was a poor predictor of neoplasia in IPMNs (AUC = 0.55). Amylase did not distinguish IPMNs from mucinous cystadenomas (MCAs) (median, 3759 U/L [n = 28 IPMNs] and 497 U/L [n = 3 MCAs], AUC = 0.65).
  
  
  
  Cytology has a limited role because of its lack of sensitivity. Carcinoembryonic antigen modestly differentiated between mucinous and nonmucinous lesions. Amylase did not distinguish IPMNs versus MCAs.
authors.affiliation: From the *Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL; †Programa de Doctorat en Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; ‡San Raffaele Scientific Institute, Milano, Italy; §Azienda Universitario-Ospedaliera San Giovanni Battista, Torino, Italy; ∥University of Bologna/Hospital of Imola, Imola, Italy; and ¶Department of Surgery, Mayo Clinic, Jacksonville, FL.
authors.forename: Maria
authors.initials: M
authors.lastname: Moris
authors.forename: Massimo
authors.initials: M
authors.lastname: Raimondo
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Woodward
authors.forename: Verna
authors.initials: V
authors.lastname: Skinner
authors.forename: Paolo G
authors.initials: PG
authors.lastname: Arcidiacono
authors.forename: Maria C
authors.initials: MC
authors.lastname: Petrone
authors.forename: Claudio
authors.initials: C
authors.lastname: De Angelis
authors.forename: Selene
authors.initials: S
authors.lastname: Manfrè
authors.forename: Pietro
authors.initials: P
authors.lastname: Fusaroli
authors.forename: Horacio
authors.initials: H
authors.lastname: Asbun
authors.forename: John
authors.initials: J
authors.lastname: Stauffer
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D000368:Aged; D000681:Amylases / Q000378:metabolism*; D002272:Carcinoembryonic Antigen / Q000378:metabolism*; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D002291:Carcinoma, Papillary / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D002272:Carcinoembryonic Antigen; D000681:Amylases