Intracystic glucose and carcinoembryonic antigen in differentiating histologically-confirmed pancreatic mucinous neoplastic cysts.
Por:
Smith ZL, Satyavada S, Simons-Linares R, Mok SR, Moreno BM, Aparicio JR and Chahal P
Publicada:
1 mar 2022
Ahead of Print:
31 dic 2021
Resumen:
INTRODUCTION: Differentiating mucinous neoplastic pancreatic cysts (MNPCs) from cysts without malignant potential can be challenging. Guidelines recommend using fluid carcinoembryonic antigen (CEA) to differentiate MNPCs, however its sensitivity and specificity vary widely. Intracystic glucose concentration has shown promise in differentiating MNPCs, but data are limited to frozen specimens and cohorts of patients without histologic diagnoses. This study aimed to compare glucose and CEA concentrations in differentiating MNPC using fresh fluid obtained from cysts with confirmatory histologic diagnoses. METHODS: This was a multicenter cohort study of patients undergoing endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for pancreatic cysts from January 2013 - May 2020. Patients were included if the cyst had a histologic diagnosis, and if both CEA and glucose were analyzed from fresh fluid. Receiver operator curve (ROC) characteristics were analyzed and various diagnostic parameters were compared. RESULTS: Ninety-three patients met eligibility criteria, 59 with MNPCs. The areas under the receiver operating curve (AUROC) were 0.96 for glucose and 0.81 for CEA (difference 0.145, P=0.003). A CEA of =192 ng/ml had a sensitivity of 62.7% and specificity of 88.2% in differentiating MNPCs, while glucose =25 mg/dl had a sensitivity and specificity of 88.1% and 91.2%. CONCLUSION: Intracystic glucose is superior to CEA concentration for differentiating MNPCs when analyzed from freshly-obtained fluid of cysts with histologic diagnoses. The advantage of glucose is augmented by its low cost and ease of implementation and therefore, its widespread adoption should come without barriers. Glucose has supplanted CEA as the best fluid biomarker in differentiating MNPCs.
Filiaciones:
Smith ZL:
Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI
Division of Gastroenterology and Liver Disease, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH
Satyavada S:
Division of Gastroenterology and Liver Disease, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH
Simons-Linares R:
Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH
Mok SR:
Division of Gastroenterology and Liver Disease, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH
:
Endoscopy Unit. ISABIAL. Hospital General Universitario de Alicante, Alicante. Spain
:
Endoscopy Unit. ISABIAL. Hospital General Universitario de Alicante, Alicante. Spain
Chahal P:
Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH
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