Diagnostic performance of cyst fluid carcinoembryonic antigen and amylase in histologically confirmed pancreatic cysts

Walter Gwang Up Park, Ranjan Mascarenhas, Mario Palaez-Luna, Thomas Christopher Smyrk, Dennis O'Kane, Jonathan E. Clain, Michael J. Levy, Randall K. Pearson, Bret Thomas Petersen, Mark Topazian, Santhi Swaroop Vege, Suresh T Chari

Research output: Contribution to journalArticle

94 Citations (Scopus)

Abstract

Objectives: The objective of this study was to evaluate and validate cyst fluid carcinoembyronic antigen (CEA) and amylase in differentiating (1) nonmucinous from mucinous pancreatic cystic lesions (PCLs), (2) benign mucinous from malignant mucinous PCLs, and (3) pseudocysts from nonpseudocysts (amylase only). Methods: A retrospective analysis of patients with histologically confirmed PCLs from February 1996 to April 2007 was performed. Cyst fluid CEA (n = 124) and/or amylase (n = 91) were measured and correlated to cyst type. Results: Carcinoembyronic antigen levels (P = 0.0001), but not amylase, were higher in mucinous versus nonmucinous cysts. The sensitivity, specificity, and diagnostic accuracy of CEA 200 ng/mL or greater for the diagnosis of mucinous PCLs were 60%, 93%, and 72%, respectively. Carcinoembyronic antigen levels did not differentiate benign from malignant mucinous cysts. Whereas amylase levels were higher in pseudocysts than nonpseudocysts (P = 0.009), 54% of noninflammatory PCLs had a level greater than 250 IU/L, including mucinous cystic neoplasms (median, 6800 IU/L; interquartile range, 70-25,295 IU/L). Malignant mucinous cysts had lower amylase levels than benign mucinous cysts (P = 0.0008). Conclusions: Cyst fluid CEA and amylase levels are suggestive but not diagnostic in differentiating PCLs. Unlike CEA, amylase may help differentiate benign from malignant mucinous cysts. Novel biomarkers are needed.

Original languageEnglish (US)
Pages (from-to)42-45
Number of pages4
JournalPancreas
Volume40
Issue number1
DOIs
StatePublished - Jan 2011

Fingerprint

Pancreatic Cyst
Cyst Fluid
Carcinoembryonic Antigen
Amylases
Cysts
Antigens
Biomarkers
Sensitivity and Specificity

Keywords

  • amylase
  • biological tumor marker
  • carcinoembryonic antigen
  • neoplasms, cystic, mucinous, and serous
  • pancreatic cysts

ASJC Scopus subject areas

  • Hepatology
  • Internal Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

Diagnostic performance of cyst fluid carcinoembryonic antigen and amylase in histologically confirmed pancreatic cysts. / Park, Walter Gwang Up; Mascarenhas, Ranjan; Palaez-Luna, Mario; Smyrk, Thomas Christopher; O'Kane, Dennis; Clain, Jonathan E.; Levy, Michael J.; Pearson, Randall K.; Petersen, Bret Thomas; Topazian, Mark; Vege, Santhi Swaroop; Chari, Suresh T.

In: Pancreas, Vol. 40, No. 1, 01.2011, p. 42-45.

Research output: Contribution to journalArticle

Park, Walter Gwang Up ; Mascarenhas, Ranjan ; Palaez-Luna, Mario ; Smyrk, Thomas Christopher ; O'Kane, Dennis ; Clain, Jonathan E. ; Levy, Michael J. ; Pearson, Randall K. ; Petersen, Bret Thomas ; Topazian, Mark ; Vege, Santhi Swaroop ; Chari, Suresh T. / Diagnostic performance of cyst fluid carcinoembryonic antigen and amylase in histologically confirmed pancreatic cysts. In: Pancreas. 2011 ; Vol. 40, No. 1. pp. 42-45.
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T1 - Diagnostic performance of cyst fluid carcinoembryonic antigen and amylase in histologically confirmed pancreatic cysts

AU - Park, Walter Gwang Up

AU - Mascarenhas, Ranjan

AU - Palaez-Luna, Mario

AU - Smyrk, Thomas Christopher

AU - O'Kane, Dennis

AU - Clain, Jonathan E.

AU - Levy, Michael J.

AU - Pearson, Randall K.

AU - Petersen, Bret Thomas

AU - Topazian, Mark

AU - Vege, Santhi Swaroop

AU - Chari, Suresh T

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N2 - Objectives: The objective of this study was to evaluate and validate cyst fluid carcinoembyronic antigen (CEA) and amylase in differentiating (1) nonmucinous from mucinous pancreatic cystic lesions (PCLs), (2) benign mucinous from malignant mucinous PCLs, and (3) pseudocysts from nonpseudocysts (amylase only). Methods: A retrospective analysis of patients with histologically confirmed PCLs from February 1996 to April 2007 was performed. Cyst fluid CEA (n = 124) and/or amylase (n = 91) were measured and correlated to cyst type. Results: Carcinoembyronic antigen levels (P = 0.0001), but not amylase, were higher in mucinous versus nonmucinous cysts. The sensitivity, specificity, and diagnostic accuracy of CEA 200 ng/mL or greater for the diagnosis of mucinous PCLs were 60%, 93%, and 72%, respectively. Carcinoembyronic antigen levels did not differentiate benign from malignant mucinous cysts. Whereas amylase levels were higher in pseudocysts than nonpseudocysts (P = 0.009), 54% of noninflammatory PCLs had a level greater than 250 IU/L, including mucinous cystic neoplasms (median, 6800 IU/L; interquartile range, 70-25,295 IU/L). Malignant mucinous cysts had lower amylase levels than benign mucinous cysts (P = 0.0008). Conclusions: Cyst fluid CEA and amylase levels are suggestive but not diagnostic in differentiating PCLs. Unlike CEA, amylase may help differentiate benign from malignant mucinous cysts. Novel biomarkers are needed.

AB - Objectives: The objective of this study was to evaluate and validate cyst fluid carcinoembyronic antigen (CEA) and amylase in differentiating (1) nonmucinous from mucinous pancreatic cystic lesions (PCLs), (2) benign mucinous from malignant mucinous PCLs, and (3) pseudocysts from nonpseudocysts (amylase only). Methods: A retrospective analysis of patients with histologically confirmed PCLs from February 1996 to April 2007 was performed. Cyst fluid CEA (n = 124) and/or amylase (n = 91) were measured and correlated to cyst type. Results: Carcinoembyronic antigen levels (P = 0.0001), but not amylase, were higher in mucinous versus nonmucinous cysts. The sensitivity, specificity, and diagnostic accuracy of CEA 200 ng/mL or greater for the diagnosis of mucinous PCLs were 60%, 93%, and 72%, respectively. Carcinoembyronic antigen levels did not differentiate benign from malignant mucinous cysts. Whereas amylase levels were higher in pseudocysts than nonpseudocysts (P = 0.009), 54% of noninflammatory PCLs had a level greater than 250 IU/L, including mucinous cystic neoplasms (median, 6800 IU/L; interquartile range, 70-25,295 IU/L). Malignant mucinous cysts had lower amylase levels than benign mucinous cysts (P = 0.0008). Conclusions: Cyst fluid CEA and amylase levels are suggestive but not diagnostic in differentiating PCLs. Unlike CEA, amylase may help differentiate benign from malignant mucinous cysts. Novel biomarkers are needed.

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KW - biological tumor marker

KW - carcinoembryonic antigen

KW - neoplasms, cystic, mucinous, and serous

KW - pancreatic cysts

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