title: Role of biochemistry and cytological analysis of cyst fluid for the differential diagnosis of pancreatic cysts: A retrospective cohort study.
abstract: BACKGROUND
  Management of pancreatic cysts is based on neoplastic-nonneoplastic discrimination. Endoscopic ultrasound (EUS) enables to differentiate neoplastic-nonneoplastic lesions and also allows fine-needle aspiration (FNA). In this study, we aim to assess feasibility and clinical relevance of cytological and biochemical analysis in differential diagnosis of cystic pancreatic lesions in patients who had undergone endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) due to pancreatic cysts.
  
  
  METHODS
  Participants were 96 patients who had undergone EUS-FNA for differential diagnosis of pancreatic cysts. Pancreatic cysts were classified as benign-mucinous, nonmucinous, and malignant according to patient history, physical examination, EUS appearance, and cystic fluid assessment. Tumor markers (CEA, CA(cancer antigens) 72.4, CA 19-9) , amylase, lipase and cytological assesment were compared between 3 different groups. Receiver-operating characteristics (ROC) curves were constructed to identify appropriate cut-off values.
  
  
  RESULTS
  Fluid CEA and CA 72.4 levels for benign-mucinous and malignant cysts were significantly higher than for nonmucinous cysts (P ≤ 0.04). A cut-off CEA level of 207 ng/mL differentiated mucinous etiology with a sensitivity of 72.7%, specificity of 97.7%, and accuracy of 89.5%. The sensitivity, specificity, and accuracy of the CA 72.4 cut-off level of 3.32 ng/mL were 80%, 69.5%, and 73.6%, respectively.
  
  
  CONCLUSIONS
  Cyst fluid CEA and CA 72.4 levels have a high accuracy in discriminating mucinous from nonmucinous cysts. When combined with cytology their accuracy rate increases.
authors.affiliation: Department of Gastroenterohepatology Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Ozlem Mutluay
authors.initials: OM
authors.lastname: Soyer
authors.forename: Bulent
authors.initials: B
authors.lastname: Baran
authors.forename: Asli Ciftcibasi
authors.initials: AC
authors.lastname: Ormeci
authors.forename: Davut
authors.initials: D
authors.lastname: Sahin
authors.forename: Suut
authors.initials: S
authors.lastname: Gokturk
authors.forename: Sami
authors.initials: S
authors.lastname: Evirgen
authors.forename: Rafet
authors.initials: R
authors.lastname: Basar
authors.forename: Pinar
authors.initials: P
authors.lastname: Firat
authors.forename: Filiz
authors.initials: F
authors.lastname: Akyuz
authors.forename: Kadir
authors.initials: K
authors.lastname: Demir
authors.forename: Fatih
authors.initials: F
authors.lastname: Besisik
authors.forename: Sabahattin
authors.initials: S
authors.lastname: Kaymakoglu
authors.forename: Cetin
authors.initials: C
authors.lastname: Karaca
mesh_terms: D000328:Adult; D000368:Aged; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000032:analysis*; D014408:Biomarkers, Tumor / Q000032:analysis; D002272:Carcinoembryonic Antigen / Q000032:analysis*; D015331:Cohort Studies; D020420:Cyst Fluid / Q000737:chemistry / Q000378:metabolism; D003937:Diagnosis, Differential; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010181:Pancreatic Cyst / Q000737:chemistry / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000737:chemistry / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology; D012189:Retrospective Studies; D014421:Turkey
chemical_list: D015295:Antigens, Tumor-Associated, Carbohydrate; D014408:Biomarkers, Tumor; C083825:CA-72-4 antigen; D002272:Carcinoembryonic Antigen