Journal of Gastrointestinal Surgery

, Volume 14, Issue 12, pp 1997–2003

Evaluation of Cyst Fluid CEA Analysis in the Diagnosis of Mucinous Cysts of the Pancreas

  • Satish Nagula
  • Timothy Kennedy
  • Mark A. Schattner
  • Murray F. Brennan
  • Hans Gerdes
  • Arnold J. Markowitz
  • Laura Tang
  • Peter J. Allen
Original Article

DOI: 10.1007/s11605-010-1281-0

Cite this article as:
Nagula, S., Kennedy, T., Schattner, M.A. et al. J Gastrointest Surg (2010) 14: 1997. doi:10.1007/s11605-010-1281-0

Abstract

Background

Although cyst fluid carcinoembryonic antigen (CEA; >192 ng/ml) is the preferred test for identifying mucinous pancreatic cysts, the data are more robust for mucinous cystic neoplasms (MCN) than for intraductal papillary mucinous neoplasms (IPMN). The role of cyst fluid CEA as a marker for either malignancy or malignant progression is uncertain.

Methods

All patients with pancreatic cysts who had undergone endoscopic ultrasound with cyst fluid CEA measurement between 2001 and 2009 were identified. Patient outcomes and pathology from operative resections were recorded.

Results

Two hundred sixty-seven patients were identified; pathological diagnosis was obtained in 97. Mucinous cysts were identified in 66 of 97 (68%): benign IPMN, n = 42; malignant IPMN, n = 10; benign MCN, n = 12; malignant MCN, n = 2. CEA > 192 ng/mL had a sensitivity and specificity of 73% and 65% for identifying mucinous cysts; cyst fluid CEA was not associated with malignancy (p = 0.85). One hundred seventy-eight patients were managed with an initial non-operative strategy. Eight (4%) developed radiographic changes necessitating surgery; pathology demonstrated seven benign mucinous cysts and one retention cyst. CEA was not associated with radiographic progression (p = 0.37).

Conclusions

Cyst fluid CEA is a useful test for identifying mucinous cysts, including MCN and IPMN. In mucinous cysts, cyst fluid CEA is not associated with malignancy or radiographic progression.

Keywords

Cystic pancreatic neoplasm Mucinous cystic neoplasm Intraductal papillary mucinous neoplasm Pancreatic cancer 

Copyright information

© The Society for Surgery of the Alimentary Tract 2010

Authors and Affiliations

  • Satish Nagula
    • 1
  • Timothy Kennedy
    • 2
  • Mark A. Schattner
    • 1
  • Murray F. Brennan
    • 2
  • Hans Gerdes
    • 1
  • Arnold J. Markowitz
    • 1
  • Laura Tang
    • 3
  • Peter J. Allen
    • 2
  1. 1.Gastroenterology & Nutrition Service, Department of MedicineMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  3. 3.Department of PathologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA