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Lower cyst fluid carcinoembryonic antigen cutoff is helpful in the differential diagnosis of mucinous versus non-mucinous pancreatic cysts

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Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background and Aim

Pancreatic cystic lesions (PCLs) are being diagnosed with increased frequency and have varying neoplastic potential. We conducted this multimodal, prospective study to evaluate  the role of tumor cytology and molecular markers to differentiate PCL subtypes.

Methods

Consecutive undiagnosed patients with PCLs (n = 100, mean age: 50.37 years; 41% males) were prospectively studied. Cyst fluid carcinoembryonic antigen (CEA), CA19.9, CA125, CA72.4, and vascular endothelial growth factor-alpha (VEGF-α) levels were measured by quantitative enzyme-linked immunosorbent assay (ELISA) method. Mutational analysis of the KRAS gene (exon 2, Codon 12 and 13) and GNAS gene (Exon 8, Codon 201) were performed by Sanger’s sequencing.

Results

The mean cyst size was 4.32 ± 2.4 cm. Fluid cytology revealed definitive diagnosis in 21 (22.3%) patients. All malignant PCLs could be identified on cytology whereas 10/14 (71%) non-malignant mucinous PCLs could also be identified on cytology based on mucin staining. Among the tested tumor markers, cyst fluid CEA had the best diagnostic performance for differentiation between mucinous and non-mucinous PCLs (AUC 0.933 [95% CI 0.86–0.91]). At a cyst fluid CEA cutoff level of 45.0 ng/mL, the sensitivity, specificity, positive predictive value, and negative predictive value for differentiation between mucinous and non-mucinous cysts were 88.5%, 96.8%, 92.0%, and 95.3%, respectively (p < 0.05). KRAS and GNAS mutation had no significant diagnostic benefit in comparison to fluid cytology and CEA levels.

Conclusions

Fluid CEA at a lower cutoff of 45 ng/mL is the most accurate marker to differentiate between mucinous and non-mucinous PCL. The KRAS and GNAS mutational analysis does not improve upon the diagnostic performance of fluid cytology and tumor markers.

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Authors and Affiliations

  1. Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Ravi Kumar Sharma, Nikhil Bush & Surinder Singh Rana

  2. Department of Cytology and Gynecology Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Radhika Srinivasan

  3. Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Ritambhra Nada

  4. Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Rajesh Gupta

  5. Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Satyavati Rana & Tarundeep Singh

Authors
  1. Ravi Kumar Sharma
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  2. Nikhil Bush
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Contributions

Ravi Kumar Sharma: drafting of manuscript, collection and analysis of data. Nikhil Bush: drafting of manuscript, analysis of data. Surinder Singh Rana: analysis of data, critical evaluation of manuscript. Radhika Srinivasan: collection and analysis of data. Ritambhra Nada: collection and analysis of data. Rajesh Gupta: collection and analysis of data. Satyavati Rana: collection and analysis of data. Tarundeep Singh: collection and analysis of data.

Corresponding author

Correspondence to Surinder Singh Rana.

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Conflict of interest

 RKS, NB, SSR, RS, RN, RG, SR, and TS declare no competing interests.

Ethics statement

The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article.

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Sharma, R.K., Bush, N., Rana, S.S. et al. Lower cyst fluid carcinoembryonic antigen cutoff is helpful in the differential diagnosis of mucinous versus non-mucinous pancreatic cysts. Indian J Gastroenterol 41, 397–404 (2022). https://doi.org/10.1007/s12664-022-01269-w

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