The majority of
pancreatic cysts are detected incidentally when abdominal imaging is performed during unrelated procedures. The aim of the present study was to assess the diagnostic utility and clinical value of
carcinoembryonic antigen (CEA),
carbohydrate antigen 19-9 (CA 19-9) and
amylase analysis in
pancreatic cyst fluid. The study included 52 patients with pancreatic cystic lesions, who underwent fine-needle aspiration biopsy to collect cystic fluid for cytological and biochemical analysis.
Cysts were classified as benign (simple
cysts, pseudocysts and
serous cystadenomas) in 36 patients or premalignant/malignant (mucinous
cyst-
adenomas, intraductal papillary
mucinous neoplasm and
cystadenocarcinomas) in 16 patients. CEA and CA 19-9 were elevated in patients with malignant
cysts (238±12.5 ng/ml and 222±31.5 U/ml, respectively) compared with benign lesions (34.5±3.7 ng/ml and 18.5±1.9 U/ml, respectively; P<0.001). Based on these results, the sensitivity and specificity of CEA were 91.8 and 63.9% and of CA 19-9 were 81.3 and 69.4%, respectively. Mean
amylase levels in benign lesions (27825.7±91.9 U/l) were higher compared with malignant
pancreatic cysts (8359.2±32.7 U/l; P<0.05). Cyst fluid analysis may prove a safe and useful adjunct for the differential diagnosis of pancreatic cystic lesions. In the present study, promising results for CEA and CA 19-9 have been demonstrated, however, the clinical value of these molecules must be confirmed.