Original ArticleCyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis
Section snippets
Patients and methods
A search in PubMed was performed in June 2004 with the search terms cyst, pancrea, and fluid. Articles about cyst fluid analysis of pancreatic lesions were included if (a) the individual data of at least 7 patients were present, (b) the diagnosis of a cystadenoma was made by pathologic examination, and (c) the diagnosis of PC was made by pathologic examination or by the presence of a pancreatic cyst in a patient with a history of acute pancreatitis or well-documented chronic pancreatitis in
Results
The PubMed search revealed 12 studies that comprised individual cyst-fluid concentrations of amylase, CA 19-9, or CEA of in total 450 patients (Table 1).1, 2, 3, 7, 9, 10, 11, 12, 13, 14, 15, 16 Two articles from one group partially described the same patient data about the CEA concentrations; duplicate data were excluded.11, 15 In most studies, patients were only included after histologic confirmation of their diagnosis. The diagnosis of nearly all MCA or MCAC was proven by histology or
CEA
The 332 individual CEA concentrations in cyst fluid of PC (n = 125; median, 10 ng/mL), SCA (n = 79; median, 3 ng/mL), MCA (n = 64; median, 400 ng/mL), and MCAC (n = 64; median, 2000 ng/mL) are shown in Figure 2. With a cutoff value of <5 ng/mL (the upper limit of normal serum values of CEA), a clear distinction between MCA/MCAC from SCA/PC was observed (Fig. 2). Cysts with CEA < 5 ng/mL were SCA or PC (sensitivity 50%, specificity 95%, PPV 94%, NPV 55%, accuracy 67%). In one study,16 the CEA
Discussion
Symptomatic resectable lesions should be removed without the need for fluid analysis. However, in asymptomatic patients, in patients with an increased surgical risk, and in patients in whom there is a diagnostic uncertainty about the presence of a PC, it is important to distinguish premalignant or malignant tumors, such as MCA and MCAC from benign tumors, such as PC and SCA. Unfortunately, radiologic criteria have a relatively low accuracy.1, 2, 8 In the present study, we performed a pooled
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See CME section; p. 414.