Suboptimal accuracy of carcinoembryonic antigen in differentiation of mucinous and nonmucinous pancreatic cysts: results of a large multicenter study

Srinivas Gaddam, Phillip S. Ge, Joseph W. Keach, Daniel Mullady, Norio Fukami, Steven A. Edmundowicz, Riad R. Azar, Raj J. Shah, Faris M. Murad, Vladimir M. Kushnir, Rabindra R. Watson, Kourosh F. Ghassemi, Alireza Sedarat, Srinadh Komanduri, Diana Marie Jaiyeola, Brian C. Brauer, Roy D. Yen, Stuart K. Amateau, Lindsay Hosford, Thomas HollanderTimothy R. Donahue, Richard D. Schulick, Barish H. Edil, Martin Mccarter, Csaba Gajdos, Augustin Attwell, V. Raman Muthusamy, Dayna S. Early, Sachin Wani

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background and Aims The exact cutoff value at which pancreatic cyst fluid carcinoembryonic antigen (CEA) level distinguishes pancreatic mucinous cystic neoplasms (MCNs) from pancreatic nonmucinous cystic neoplasms (NMCNs) is unclear. The aim of this multicenter retrospective study was to evaluate the diagnostic accuracy of cyst fluid CEA levels in differentiating between MCNs and NMCNs. Methods Consecutive patients who underwent EUS with FNA at 3 tertiary care centers were identified. Patients with histologic confirmation of cyst type based on surgical specimens served as the criterion standard for this analysis. Demographic characteristics, EUS morphology, FNA fluid, and cytology results were recorded. Multivariate logistic regression analysis to identify predictors of MCNs was performed. Receiver-operating characteristic (ROC) curves were generated for CEA levels. Results A total of 226 patients underwent surgery (mean age, 61 years, 96% white patients, 39% female patients) of whom 88% underwent Whipple's procedure or distal pancreatectomy. Based on surgical histopathology, there were 150 MCNs and 76 NMCNs cases. The median CEA level was 165 ng/mL. The area under the ROC curve for CEA levels in differentiating between MCNs and NMCNs was 0.77 (95% confidence interval, 0.71-0.84, P <.01) with a cutoff of 105 ng/mL, demonstrating a sensitivity and specificity of 70% and 63%, respectively. The cutoff value of 192 ng/mL yielded a sensitivity of 61% and a specificity of 77% and would misdiagnose 39% of MCN cases. Conclusions Cyst fluid CEA levels have a clinically suboptimal accuracy level in differentiating MCNs from NMCNs. Future studies should focus on novel cyst fluid markers to improve risk stratification of pancreatic cystic neoplasms.

Original languageEnglish (US)
Pages (from-to)1060-1069
Number of pages10
JournalGastrointestinal Endoscopy
Volume82
Issue number6
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

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Pancreatic Cyst
Carcinoembryonic Antigen
Multicenter Studies
Cyst Fluid
Neoplasms
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Pancreatic Neoplasms
ROC Curve
Pancreatectomy
Diagnostic Errors
Tertiary Care Centers
Cell Biology
Cysts

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Suboptimal accuracy of carcinoembryonic antigen in differentiation of mucinous and nonmucinous pancreatic cysts : results of a large multicenter study. / Gaddam, Srinivas; Ge, Phillip S.; Keach, Joseph W.; Mullady, Daniel; Fukami, Norio; Edmundowicz, Steven A.; Azar, Riad R.; Shah, Raj J.; Murad, Faris M.; Kushnir, Vladimir M.; Watson, Rabindra R.; Ghassemi, Kourosh F.; Sedarat, Alireza; Komanduri, Srinadh; Jaiyeola, Diana Marie; Brauer, Brian C.; Yen, Roy D.; Amateau, Stuart K.; Hosford, Lindsay; Hollander, Thomas; Donahue, Timothy R.; Schulick, Richard D.; Edil, Barish H.; Mccarter, Martin; Gajdos, Csaba; Attwell, Augustin; Muthusamy, V. Raman; Early, Dayna S.; Wani, Sachin.

In: Gastrointestinal Endoscopy, Vol. 82, No. 6, 01.12.2015, p. 1060-1069.

Research output: Contribution to journalArticle

Gaddam, S, Ge, PS, Keach, JW, Mullady, D, Fukami, N, Edmundowicz, SA, Azar, RR, Shah, RJ, Murad, FM, Kushnir, VM, Watson, RR, Ghassemi, KF, Sedarat, A, Komanduri, S, Jaiyeola, DM, Brauer, BC, Yen, RD, Amateau, SK, Hosford, L, Hollander, T, Donahue, TR, Schulick, RD, Edil, BH, Mccarter, M, Gajdos, C, Attwell, A, Muthusamy, VR, Early, DS & Wani, S 2015, 'Suboptimal accuracy of carcinoembryonic antigen in differentiation of mucinous and nonmucinous pancreatic cysts: results of a large multicenter study', Gastrointestinal Endoscopy, vol. 82, no. 6, pp. 1060-1069. https://doi.org/10.1016/j.gie.2015.04.040
Gaddam, Srinivas ; Ge, Phillip S. ; Keach, Joseph W. ; Mullady, Daniel ; Fukami, Norio ; Edmundowicz, Steven A. ; Azar, Riad R. ; Shah, Raj J. ; Murad, Faris M. ; Kushnir, Vladimir M. ; Watson, Rabindra R. ; Ghassemi, Kourosh F. ; Sedarat, Alireza ; Komanduri, Srinadh ; Jaiyeola, Diana Marie ; Brauer, Brian C. ; Yen, Roy D. ; Amateau, Stuart K. ; Hosford, Lindsay ; Hollander, Thomas ; Donahue, Timothy R. ; Schulick, Richard D. ; Edil, Barish H. ; Mccarter, Martin ; Gajdos, Csaba ; Attwell, Augustin ; Muthusamy, V. Raman ; Early, Dayna S. ; Wani, Sachin. / Suboptimal accuracy of carcinoembryonic antigen in differentiation of mucinous and nonmucinous pancreatic cysts : results of a large multicenter study. In: Gastrointestinal Endoscopy. 2015 ; Vol. 82, No. 6. pp. 1060-1069.
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abstract = "Background and Aims The exact cutoff value at which pancreatic cyst fluid carcinoembryonic antigen (CEA) level distinguishes pancreatic mucinous cystic neoplasms (MCNs) from pancreatic nonmucinous cystic neoplasms (NMCNs) is unclear. The aim of this multicenter retrospective study was to evaluate the diagnostic accuracy of cyst fluid CEA levels in differentiating between MCNs and NMCNs. Methods Consecutive patients who underwent EUS with FNA at 3 tertiary care centers were identified. Patients with histologic confirmation of cyst type based on surgical specimens served as the criterion standard for this analysis. Demographic characteristics, EUS morphology, FNA fluid, and cytology results were recorded. Multivariate logistic regression analysis to identify predictors of MCNs was performed. Receiver-operating characteristic (ROC) curves were generated for CEA levels. Results A total of 226 patients underwent surgery (mean age, 61 years, 96{\%} white patients, 39{\%} female patients) of whom 88{\%} underwent Whipple's procedure or distal pancreatectomy. Based on surgical histopathology, there were 150 MCNs and 76 NMCNs cases. The median CEA level was 165 ng/mL. The area under the ROC curve for CEA levels in differentiating between MCNs and NMCNs was 0.77 (95{\%} confidence interval, 0.71-0.84, P <.01) with a cutoff of 105 ng/mL, demonstrating a sensitivity and specificity of 70{\%} and 63{\%}, respectively. The cutoff value of 192 ng/mL yielded a sensitivity of 61{\%} and a specificity of 77{\%} and would misdiagnose 39{\%} of MCN cases. Conclusions Cyst fluid CEA levels have a clinically suboptimal accuracy level in differentiating MCNs from NMCNs. Future studies should focus on novel cyst fluid markers to improve risk stratification of pancreatic cystic neoplasms.",
author = "Srinivas Gaddam and Ge, {Phillip S.} and Keach, {Joseph W.} and Daniel Mullady and Norio Fukami and Edmundowicz, {Steven A.} and Azar, {Riad R.} and Shah, {Raj J.} and Murad, {Faris M.} and Kushnir, {Vladimir M.} and Watson, {Rabindra R.} and Ghassemi, {Kourosh F.} and Alireza Sedarat and Srinadh Komanduri and Jaiyeola, {Diana Marie} and Brauer, {Brian C.} and Yen, {Roy D.} and Amateau, {Stuart K.} and Lindsay Hosford and Thomas Hollander and Donahue, {Timothy R.} and Schulick, {Richard D.} and Edil, {Barish H.} and Martin Mccarter and Csaba Gajdos and Augustin Attwell and Muthusamy, {V. Raman} and Early, {Dayna S.} and Sachin Wani",
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TY - JOUR

T1 - Suboptimal accuracy of carcinoembryonic antigen in differentiation of mucinous and nonmucinous pancreatic cysts

T2 - results of a large multicenter study

AU - Gaddam, Srinivas

AU - Ge, Phillip S.

AU - Keach, Joseph W.

AU - Mullady, Daniel

AU - Fukami, Norio

AU - Edmundowicz, Steven A.

AU - Azar, Riad R.

AU - Shah, Raj J.

AU - Murad, Faris M.

AU - Kushnir, Vladimir M.

AU - Watson, Rabindra R.

AU - Ghassemi, Kourosh F.

AU - Sedarat, Alireza

AU - Komanduri, Srinadh

AU - Jaiyeola, Diana Marie

AU - Brauer, Brian C.

AU - Yen, Roy D.

AU - Amateau, Stuart K.

AU - Hosford, Lindsay

AU - Hollander, Thomas

AU - Donahue, Timothy R.

AU - Schulick, Richard D.

AU - Edil, Barish H.

AU - Mccarter, Martin

AU - Gajdos, Csaba

AU - Attwell, Augustin

AU - Muthusamy, V. Raman

AU - Early, Dayna S.

AU - Wani, Sachin

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Background and Aims The exact cutoff value at which pancreatic cyst fluid carcinoembryonic antigen (CEA) level distinguishes pancreatic mucinous cystic neoplasms (MCNs) from pancreatic nonmucinous cystic neoplasms (NMCNs) is unclear. The aim of this multicenter retrospective study was to evaluate the diagnostic accuracy of cyst fluid CEA levels in differentiating between MCNs and NMCNs. Methods Consecutive patients who underwent EUS with FNA at 3 tertiary care centers were identified. Patients with histologic confirmation of cyst type based on surgical specimens served as the criterion standard for this analysis. Demographic characteristics, EUS morphology, FNA fluid, and cytology results were recorded. Multivariate logistic regression analysis to identify predictors of MCNs was performed. Receiver-operating characteristic (ROC) curves were generated for CEA levels. Results A total of 226 patients underwent surgery (mean age, 61 years, 96% white patients, 39% female patients) of whom 88% underwent Whipple's procedure or distal pancreatectomy. Based on surgical histopathology, there were 150 MCNs and 76 NMCNs cases. The median CEA level was 165 ng/mL. The area under the ROC curve for CEA levels in differentiating between MCNs and NMCNs was 0.77 (95% confidence interval, 0.71-0.84, P <.01) with a cutoff of 105 ng/mL, demonstrating a sensitivity and specificity of 70% and 63%, respectively. The cutoff value of 192 ng/mL yielded a sensitivity of 61% and a specificity of 77% and would misdiagnose 39% of MCN cases. Conclusions Cyst fluid CEA levels have a clinically suboptimal accuracy level in differentiating MCNs from NMCNs. Future studies should focus on novel cyst fluid markers to improve risk stratification of pancreatic cystic neoplasms.

AB - Background and Aims The exact cutoff value at which pancreatic cyst fluid carcinoembryonic antigen (CEA) level distinguishes pancreatic mucinous cystic neoplasms (MCNs) from pancreatic nonmucinous cystic neoplasms (NMCNs) is unclear. The aim of this multicenter retrospective study was to evaluate the diagnostic accuracy of cyst fluid CEA levels in differentiating between MCNs and NMCNs. Methods Consecutive patients who underwent EUS with FNA at 3 tertiary care centers were identified. Patients with histologic confirmation of cyst type based on surgical specimens served as the criterion standard for this analysis. Demographic characteristics, EUS morphology, FNA fluid, and cytology results were recorded. Multivariate logistic regression analysis to identify predictors of MCNs was performed. Receiver-operating characteristic (ROC) curves were generated for CEA levels. Results A total of 226 patients underwent surgery (mean age, 61 years, 96% white patients, 39% female patients) of whom 88% underwent Whipple's procedure or distal pancreatectomy. Based on surgical histopathology, there were 150 MCNs and 76 NMCNs cases. The median CEA level was 165 ng/mL. The area under the ROC curve for CEA levels in differentiating between MCNs and NMCNs was 0.77 (95% confidence interval, 0.71-0.84, P <.01) with a cutoff of 105 ng/mL, demonstrating a sensitivity and specificity of 70% and 63%, respectively. The cutoff value of 192 ng/mL yielded a sensitivity of 61% and a specificity of 77% and would misdiagnose 39% of MCN cases. Conclusions Cyst fluid CEA levels have a clinically suboptimal accuracy level in differentiating MCNs from NMCNs. Future studies should focus on novel cyst fluid markers to improve risk stratification of pancreatic cystic neoplasms.

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U2 - 10.1016/j.gie.2015.04.040

DO - 10.1016/j.gie.2015.04.040

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