Köker Ibrahim Hakkı, Ünver Nurcan, Malya Fatma Ümit, Uysal Ömer, Keskin Elmas Biberci, Şentürk Hakan
Department of Gastroenterology, Bezmialem Vakif University Medicine Faculty, Istanbul, Turkey.
Department of Pathology, Bezmialem Vakif University Medicine Faculty, Istanbul, Turkey.
Clin Endosc. 2021 Jan;54(1):113-121. doi: 10.5946/ce.2020.083. Epub 2020 Dec 11.
BACKGROUND/AIMS: The role of cyst fluid carcinoembryonic antigen (CEA) level in differentiating mucinous pancreatic cystic lesions (PCLs) is controversial. We investigated the role of cyst fluid CEA in differentiating low-risk (LR)-intraductal papillary mucinous neoplasms (IPMNs) from high-risk (HR)-IPMNs and LR-mucinous cystic neoplasms (MCNs).
This was a retrospective study of 466 patients with PCLs who underwent endoscopic ultrasound-guided fine-needleaspiration over a 7-year period. On histology, low-grade dysplasia and intermediate-grade dysplasia were considered LR, whereas high-grade dysplasia and invasive carcinoma were considered HR.
Data on cyst fluid CEA levels were available for 50/102 mucinous PCLs with definitive diagnoses. The median CEA (range) levels were significantly higher in HR cysts than in LR cysts (2,624 [0.5-266,510] ng/mL vs. 100 [16.8-53,445]ng/mL, p=0.0012). The area under the receiver operating characteristic curve (AUROC) was 0.930 (95% confidence interval [CI], 0.5-0.8; p<0.001) for differentiating LR-IPMNs from LR-MCNs. The AUROC was 0.921 (95% CI, 0.823-1.000; p<0.001) for differentiating LR-IPMNs from HR-IPMNs. Both had a CEA cutoff level of >100ng/mL, with a negative predictive value (NPV) of 100%.
Cyst fluid CEA levels significantly vary between LR-IPMNs, LR-MCNs, and HR-IPMNs. A CEA cutoff level of >100ng/mL had a 100% NPV in differentiating LR-IPMNs from LR-MCNs and HR-IPMNs.
背景/目的：囊液癌胚抗原（CEA）水平在鉴别黏液性胰腺囊性病变（PCL）中的作用存在争议。我们研究了囊液CEA在鉴别低风险（LR）导管内乳头状黏液性肿瘤（IPMN）与高风险（HR）-IPMN以及LR黏液性囊性肿瘤（MCN）中的作用。
这是一项对466例PCL患者进行的回顾性研究，这些患者在7年期间接受了内镜超声引导下细针穿刺。组织学上，低级别发育异常和中级别的发育异常被视为LR，而高级别发育异常和浸润性癌被视为HR。
50/102例确诊的黏液性PCL患者有囊液CEA水平数据。HR囊肿的CEA中位数（范围）水平显著高于LR囊肿（2624[0.5 - 266510]ng/mL对100[16.8 - 53445]ng/mL，p = 0.0012）。在区分LR-IPMN与LR-MCN时，受试者工作特征曲线（AUROC）下面积为0.930（95%置信区间[CI]，0.850 - 0.980；p < 0.001）。在区分LR-IPMN与HR-IPMN时，AUROC为0.921（95%CI，0.823 - 1.000；p < 0.001）。两者的CEA临界值均>100ng/mL，阴性预测值（NPV）为100%。
LR-IPMN、LR-MCN和HR-IPMN之间囊液CEA水平存在显著差异。CEA临界值>100ng/mL在区分LR-IPMN与LR-MCN和HR-IPMN时NPV为100%。
