Gaddam Srinivas, Ge Phillip S, Keach Joseph W, Mullady Daniel, Fukami Norio, Edmundowicz Steven A, Azar Riad R, Shah Raj J, Murad Faris M, Kushnir Vladimir M, Watson Rabindra R, Ghassemi Kourosh F, Sedarat Alireza, Komanduri Srinadh, Jaiyeola Diana-Marie, Brauer Brian C, Yen Roy D, Amateau Stuart K, Hosford Lindsay, Hollander Thomas, Donahue Timothy R, Schulick Richard D, Edil Barish H, McCarter Martin, Gajdos Csaba, Attwell Augustin, Muthusamy V Raman, Early Dayna S, Wani Sachin
Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri, USA.
Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Gastrointest Endosc. 2015 Dec;82(6):1060-9. doi: 10.1016/j.gie.2015.04.040. Epub 2015 Jun 12.
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.
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.
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.
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.
胰腺囊肿液癌胚抗原（CEA）水平用于区分胰腺黏液性囊性肿瘤（MCN）与胰腺非黏液性囊性肿瘤（NMCN）的确切临界值尚不清楚。这项多中心回顾性研究的目的是评估囊肿液CEA水平在鉴别MCN与NMCN方面的诊断准确性。
确定在3家三级医疗中心接受超声内镜引导下细针穿刺活检（EUS-FNA）的连续患者。以基于手术标本的囊肿类型组织学确诊患者作为该分析的标准对照。记录人口统计学特征、EUS形态、FNA液及细胞学结果。进行多因素逻辑回归分析以确定MCN的预测因素。绘制CEA水平的受试者操作特征（ROC）曲线。
共有226例患者接受手术（平均年龄61岁，96%为白人患者，39%为女性患者），其中88%接受了惠普尔手术或胰体尾切除术。根据手术组织病理学结果，有150例MCN和76例NMCN病例。CEA水平的中位数为165 ng/mL。CEA水平鉴别MCN与NMCN的ROC曲线下面积为0.77（95%置信区间为0.71-0.84，P <.01），临界值为105 ng/mL，敏感性和特异性分别为70%和63%。临界值为192 ng/mL时，敏感性为61%，特异性为77%，会误诊39%的MCN病例。
囊肿液CEA水平在鉴别MCN与NMCN方面的临床准确性欠佳。未来研究应聚焦于新型囊肿液标志物，以改善胰腺囊性肿瘤的风险分层。
