1. EUS and EUS–FNA diagnosis of suspected pancreatic cystic neoplasms: Is the sum of the parts greater than the CEA?
- Author
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Manu Nayar, K. Elamin, Richard Charnley, Steven A. White, Kofi Oppong, V. Wadehra, and Muhammad F. Dawwas
- Subjects
Adult ,Male ,Endoscopic ultrasound ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Sensitivity and Specificity ,Benign cysts ,Endosonography ,Carcinoembryonic antigen ,Cytology ,medicine ,Humans ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,Pancreas ,neoplasms ,Aged ,Retrospective Studies ,Aged, 80 and over ,Hepatology ,medicine.diagnostic_test ,biology ,business.industry ,Gastroenterology ,Retrospective cohort study ,Middle Aged ,medicine.disease ,digestive system diseases ,Carcinoembryonic Antigen ,Pancreatic Neoplasms ,medicine.anatomical_structure ,Fine-needle aspiration ,Amylases ,biology.protein ,Female ,Radiology ,Pancreatic cysts ,Neoplasms, Cystic, Mucinous, and Serous ,business - Abstract
Carcinoembryonic antigen (CEA) is suggested as the single most useful EUS/EUS-FNA derived test for the diagnosis of mucinous pancreatic cysts.To investigate the yield and diagnostic performance of EUS/EUS-FNA on an intention to diagnose basis and to determine the utility of the recommended CEA and amylase cut-off values.A retrospective study of a prospectively maintained database of 433 procedures performed in a 10 year period. Diagnostic performance of EUS-FNA was determined in 133 procedures with a definite diagnosis.CEA value was determined in significantly fewer procedures (58.6%) than EUS diagnosis was stated (83.4%; p 0.0001), cyst fluid appearance recorded (89.4%) or adequate sample for cytology obtained (76.7%; p 0.005). Median CEA was significantly higher in mucinous cysts than non-mucinous (175 ng/ml vs 3 ng/ml, p 0.0001) and in malignant cysts compared to benign (8945 ng/ml vs 93 ng/ml, p 0.001). On an intention-to-diagnose analysis, a CEA cut-off of 110 ng/ml was significantly less accurate (42.8%) than EUS diagnosis (67.7%), cytology (58.6%) or aspirate appearance (66.9%; p 0.05 for all comparisons). However, the combination of EUS diagnosis, cytology and CEA provided higher sensitivity (91%), specificity (75%) and accuracy (85.7%) than each component test alone (p 0.05 for all comparisons). Median amylase was significantly higher in benign compared to high-risk mucinous cysts ((11,429IU/L vs. 113IU/L; p 0.05.The combination of EUS, cytology and CEA performed well. Malignant cysts had a higher CEA value than benign cysts. On an intention to diagnose basis a CEA cut-off of 110 ng/ml performed poorly.
- Published
- 2015