Department of Hepato-Pancreato-Biliary Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Surgery. 2010 Oct;148(4):638-44; discussion 644-5. doi: 10.1016/j.surg.2010.07.023. Epub 2010 Aug 24.
Differentiation between the various pathologies presenting as a cystic pancreatic lesion is clinically important but often challenging. We have previously advocated the performance of endoscopic ultrasound (EUS) with aspiration and determination of mucin and carcinoembryonic antigen (CEA) content. We sought to report the results of this ongoing protocol and determine the relative importance of cyst fluid mucin and CEA for the diagnostic process.
The institutions prospectively maintained pancreatic cyst database was accessed to identify patients who had undergone pancreatic EUS and cyst aspiration as part of their evaluation. Only those patients who had subsequently undergone resection were selected, with histopathology being the gold standard for comparison.
From January 2000 to July 2009, 174 patients with pancreatic cystic disease underwent surgery, 121 of whom had an EUS with aspiration attempted at our institution with specimens sent for mucin and CEA. Based on histopathology, 86 mucinous lesions were identified, including 44 cystadenomas, 34 intraductal papillary mucinous neoplasms, 7 mucinous adenocarcinomas, and 1 intraductal oncocytic papillary neoplasm; 42 were nonmucinous lesions. The median cyst CEA levels were significantly higher in the mucinous lesions group at 850 versus 2 ng/mL (P = .001). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive diagnostic likelihood ratio, and negative diagnostic likelihood ratio (NDLR) were calculated respectively for mucin alone (0.80, 0.40, 0.61, 0.63, 1.33, 0.68); CEA alone (0.93, 0.43, 0.51, 0.91, 1.63, 0.16); cytology alone (0.38, 0.9, 0.92, 0.31, 3.67, 0.69); mucin or CEA (0.83, 0.65, 0.87, 0.57, 2.51, 0.26); mucin or CEA or cytology (0.92, 0.52, 0.86, 0.68, 1.91, 0.15); mucin plus CEA (0.96, 0.34, 0.25, 0.97, 1.45, 0.12); mucin plus cytology (0.25, 0.97, 0.96, 0.29,7.25, 0.78); CEA plus cytology (0.12, 1.00, 1.00, 0.26, ∞, 0.88); and mucin plus CEA plus cytology (0.08, 1.00, 1.00, 0.25, ∞, 0.92).
Assessment of cyst mucin and CEA are complementary, with the best profile obtained when both markers are determined along with cytology. This combination provides a good sensitivity, PPV, and NDLR, as well as reasonable PPV and PDNR.
鉴别表现为胰腺囊性病变的各种病理是临床重要的，但通常具有挑战性。我们之前提倡进行内镜超声（EUS）检查，并抽吸囊液以确定黏蛋白和癌胚抗原（CEA）含量。我们旨在报告该正在进行的方案的结果，并确定囊液黏蛋白和 CEA 对诊断过程的相对重要性。
通过访问机构前瞻性维护的胰腺囊肿数据库，确定了在我们机构接受胰腺 EUS 和囊液抽吸作为其评估一部分的患者。仅选择随后接受手术的患者，以组织病理学作为比较的金标准。
从 2000 年 1 月至 2009 年 7 月，174 例胰腺囊性疾病患者接受了手术，其中 121 例在我们机构进行了 EUS 抽吸，并将标本送检黏蛋白和 CEA。根据组织病理学，确定了 86 例黏液性病变，包括 44 例囊腺瘤、34 例胰管内乳头状黏液性肿瘤、7 例黏液性腺癌和 1 例胰管内嗜酸细胞乳头状肿瘤；42 例为非黏液性病变。黏液性病变组的中位囊液 CEA 水平明显更高，为 850 与 2 ng/mL（P =.001）。分别计算了单独黏蛋白（0.80、0.40、0.61、0.63、1.33、0.68）、单独 CEA（0.93、0.43、0.51、0.91、1.63、0.16）、单独细胞学（0.38、0.90、0.92、0.31、3.67、0.69）、黏蛋白或 CEA（0.83、0.65、0.87、0.57、2.51、0.26）、黏蛋白或 CEA 或细胞学（0.92、0.52、0.86、0.68、1.91、0.15）、黏蛋白加 CEA（0.96、0.34、0.25、0.97、1.45、0.12）、黏蛋白加细胞学（0.25、0.97、0.96、0.29、7.25、0.78）、CEA 加细胞学（0.12、1.00、1.00、0.26、∞、0.88）以及黏蛋白加 CEA 加细胞学（0.08、1.00、1.00、0.25、∞、0.92）的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、阳性诊断似然比和阴性诊断似然比。
评估囊液黏蛋白和 CEA 是互补的，当同时确定这两种标志物以及细胞学时，可获得最佳结果。这种组合具有良好的敏感性、PPV 和 NDLR，以及合理的 PPV 和 PDNR。
