Value of EUS-FNA cytology and fluid carcinoembryonic antigen in differential diagnosis between be-nigh or malignant pancreatic cystic lesion

Abstract

Objective To study the value of EUS-FNA cytology and fluid carcinoembryonic antigen （CEA） for differential diagnosis of malignant and benign pancreatic cystic lesions. Methods Data of 27 patients who underwent EUS-FNA were reviewed. According to Youden exponent, the optimal cut-off points for cyst fluid CEA were determined by receiver operating characteristic （ROC） curve. Compared with surgical pathology, the accuracy, sensitivity, specificity, positive predictive value （PPV） and negative pre- dictive value （NPV） of the EUS imaging, cytology as well as cyst fluid CEA were determined. Results Of the 27 cases, 14 were diagnosed as benign lesions, 13 were diagnosed as malignant or premalignant lesions. The accuracy , sensitivity, specificity, PPV and NPV of EUS imaging were 77. 8% （ 21/27 ）, 69. 2% （9/13）, 85.7% （ 12/14）, 81.8% （9/11） and 75.0% （12/16）. The accuracy , sensitivity, specificity, PPV and NPV of EUS-FNA cytology were 85.2% （23/27）, 76. 9% （10/13）, 92.9% （13/14）, 90. 9% （ 10/11 ）, and 81.3% （13/16）. The corresponding values of fluid carcinoembryonic antigen under the ROC- derived ideal cut-off were 74. 1% （20/27）, 84. 6% （11/13）, 64. 3% （9/14）, 68.8% （11/16） and 81.8% （9/11） （CEA 〉 22. 24 ng/ml）. Conclusion EUS-FNA cytology is highly accurate and specific for differential diagnosis of malignant and benign pancreatic cystic lesions. Cyst fluid CEA shows better sensitivi-ty. EUS-FNA cytology and cyst fluid CEA analysis can basically meet the requirement of differentiating the benign and （pre）malignant pancreatic cystic lesions. Key words: Pancreas; Carcinoembryonic antigen; Endoscopic ultrasound-guided fineneedleas piration