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Utility of endoscopic ultrasound, cytology and fluid carcinoembryonic antigen and CA 19-9 levels in pancreatic cystic lesions

查看全文 作　　者：Abdulrahman M [1]Aljebreen;Joseph [2]Romagnuolo;Rafael [3]Perini;Francis [4]Sutherland 高影响力作者 机构地区：[1]Division of Gastroenterology, Department of Medicine, King Saud University, Riyadh, Saudi Arabia;[2]Medical University of South Carolina, Digestive Disease Center, Charleston, South Carolina, United States;[3]Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada;[4]Department of General Surgery, University of Calgary, Calgary, Alberta, Canada高影响力机构 出　　处：《World Journal of Gastroenterology》索引2007年第13卷第29期,共5页高影响力期刊 基　　金：Supported by funds from the Alberta Heritage Foundation of Medical Research 摘　　要：AIM: To assess the diagnostic accuracy of endoscopic ultrasound (EUS), fluid tumor markers and cytology in distinguishing benign from (pre)malignant pancreatic cystic lesions. METHODS: 46 consecutive patients, referred to a gastroenterologist and surgeon for a symptomatic or incidental pancreatic cyst, were reviewed. EUS, cytology, and carcinoembryonic antigen (CEA) and carbohydrate antigen (CA 19-9) levels were compared with the final diagnosis, based on surgical pathology and/or imaging follow-up of at least 12 mo. Cysts were classified as benign (pseudocyst, serous cystadenoma) or malignant/ pre-malignant (mucinous cystic neoplasm). Receiver- operator characteristics (ROC) curve analysis was performed. RESULTS: The mean age was 56 years; 29% were male and median cyst diameter was 3 cm. Final outcome was obtained in 41 (89%) patients. Twenty-three (56%) of these 41 had surgical pathology. Twenty-three (56%) had benign lesions and 18 (44%) had malignant/pre- malignant lesions. Sensitivity, specificity and positive and negative predictive value of EUS alone to distinguish benign from malignant/premalignant pancreatic cystic lesions were 50%, 56%, 36% and 54% and for cytology were 71%, 96%, 92% and 85%, respectively. The corresponding values for the ROC-derived ideal cutoffswere 75%, 90%, 75%, 90% for CA 19-9 (> 37 U/mL) and 70%, 85%, 79% and 78% for CEA (> 3.1 ng/mL). Subgroup analysis of those with surgical pathology yielded almost identical performance and cutoffs. CONCLUSION: Cytology and cyst fluid tumor marker analysis is a very useful tool in distinguishing benign from (pre)malignant pancreatic cystic lesions. 关 键 词：胰腺膀胱损伤 癌胚抗原 内窥镜检查 超声波
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