Cyst Fluid Carcinoembryonic Antigen Level Difference between Mucinous Cystic Neoplasms and Intraductal Papillary Mucinous Neoplasms

• Published in: Clinical endoscopy 2021-01, Vol.54 (1), p.113
• Main Authors: Ibrahim Hakkı Köker, Nurcan Ünver, Fatma Ümit Malya, Ömer Uysal, Elmas Biberci Keskin, Hakan Şentürk
• Format: Article
• Language: Korean
• Subjects: Carcinoembryonic antigen; Malignancy; Pancreatic cysts
• ISSN: 2234-2400

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). Methods: This was a retrospective study of 466 patients with PCLs who underwent endoscopic ultrasound-guided fine-needle-aspiration 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. Results: 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; p100 ng/mL, with a negative predictive value (NPV) of 100%. Conclusions: Cyst fluid CEA levels significantly vary between LR-IPMNs, LR-MCNs, and HR-IPMNs. A CEA cutoff level of >100 ng/mL had a 100% NPV in differentiating LR-IPMNs from LR-MCNs and HR-IPMNs. Clin Endosc 2021;54:113-121