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Carcinoembryonic antigen level in the pancreatic juice is effective in malignancy diagnosis and prediction of future malignant transformation of intraductal papillary mucinous neoplasm of the pancreas

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

The present study aimed to determine the ability of diagnosing malignancy and predicting malignant transformation in patients with IPMN using carcinoembryonic antigen (CEA) level in the pancreatic juice.

Methods

We enrolled patients with IPMN who underwent endoscopic retrograde pancreatography (ERP) between 2002 and 2018. We examined the ability of diagnosing malignancy in 63 patients who underwent surgery (surgical group). Furthermore, we examined the value of predicting malignant transformation in 52 patients who underwent follow-up for over 1 year after ERP (follow-up group).

Results

In the surgical group, the overall sensitivity and specificity of CEA level (≥ 97 ng/ml) in the pancreatic juice for diagnosing malignancy were 45% and 100%, respectively. The specificity was excellent for all IPMN types; however, the sensitivity was highest in main duct type, followed by mixed type and branch duct type. In the follow-up group, malignant transformation was observed in four patients (7.7%) during the follow-up, and the median time until malignant transformation was 58 months. High CEA level in the pancreatic juice demonstrated a statistically significant difference in multivariate analysis and was found to be an independent predictor of malignant transformation (hazard ratio 17; P = 0.02). The cumulative malignant transformation rate was significantly higher in the high CEA group than that in the low CEA group (5-year cumulative malignant transformation rates, 69% vs. 0%, P < 0.001).

Conclusions

Carcinoembryonic antigen level in the pancreatic juice is useful not only in diagnosing malignancy but also in predicting future malignant transformations in IPMN patients receiving follow-up.

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Acknowledgements

The authors would like to thank Enago (www.enago.jp) for the English language review.

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Authors and Affiliations

  1. First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan

    Hiroshi Hayakawa, Mitsuharu Fukasawa, Tadashi Sato, Shinichi Takano, Hiroko Shindo, Ei Takahashi, Sumio Hirose, Satoshi Kawakami, Yoshimitsu Fukasawa, Shinya Maekawa, Taisuke Inoue, Tatsuya Yamaguchi, Yasuhiro Nakayama & Nobuyuki Enomoto

  2. First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan

    Hiromichi Kawaida, Hiroshi Kono & Daisuke Ichikawa

  3. Department of Pathology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan

    Kunio Mochizuki & Tetsuo Kondo

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  1. Hiroshi Hayakawa
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  2. Mitsuharu Fukasawa
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  10. Yoshimitsu Fukasawa
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  19. Daisuke Ichikawa
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  20. Nobuyuki Enomoto
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Correspondence to Mitsuharu Fukasawa.

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535_2019_1592_MOESM1_ESM.tif

Supplementary figure 1 The receiver operating characteristic curve used to determine the CEA cut off levels in the pancreatic juice of patients in the surgical group. The cut-off value was determined using Youden index. The area under the curve level was 0.69. The cut-off level for diagnosing malignancy was set at 97 ng/ml. (TIFF 7 kb)

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Hayakawa, H., Fukasawa, M., Sato, T. et al. Carcinoembryonic antigen level in the pancreatic juice is effective in malignancy diagnosis and prediction of future malignant transformation of intraductal papillary mucinous neoplasm of the pancreas. J Gastroenterol 54, 1029–1037 (2019). https://doi.org/10.1007/s00535-019-01592-8

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  • DOI: https://doi.org/10.1007/s00535-019-01592-8

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