Endoscopy 2018; 50(04): S110-S111
DOI: 10.1055/s-0038-1637357
ESGE Days 2018 ePoster Podium presentations
20.04.2018 – EUS diagnostic: pancreatobiliary 1
Georg Thieme Verlag KG Stuttgart · New York

THE DIAGNOSTIC ACCURACY OF CARCINOEMBRYONIC ANTIGEN IN DIFFERENTIATING MUCINOUS AND NON-MUCINOUS PANCREATIC CYSTIC NEOPLASMS – A SYSTEMATIC REVIEW AND INDIVIDUAL PATIENT DATA META-ANALYSIS

NCM van Huijgevoort
1   Academic Medical Center Amsterdam, Amsterdam, Netherlands
,
SA Hoogenboom
1   Academic Medical Center Amsterdam, Amsterdam, Netherlands
,
SJ Lekkerkerker
1   Academic Medical Center Amsterdam, Amsterdam, Netherlands
,
MD Topazian
2   Mayo Clinic, Rochester, United States
,
V Chandrasekhara
3   University of AlabamaPennsylvania Perelman School of Medicine, Philadelphia, United States
,
G Morris-Stiff
4   Cleveland Clinic Foundation, Cleveland, United States
,
MA Al-Haddad
5   Indiana University School of Medicine, Indianapolis, United States
,
KW Oppong
6   Freeman Hospital, Newcastle upon Tyne, United Kingdom
,
A Khalid
7   University of Pittsburgh, Pittsburgh, United States
,
M del Chiaro
8   Karolinska Institute at Karolinska University Hospital, Stockholm, Sweden
,
MG Besselink
1   Academic Medical Center Amsterdam, Amsterdam, Netherlands
,
JE van Hooft
1   Academic Medical Center Amsterdam, Amsterdam, Netherlands
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

Distinction between the different types of pancreatic cystic neoplasms (PCNs) is essential, since non-mucinous cysts are benign without need for surveillance, whereas mucinous cysts are considered premalignant and require either surveillance or surgical resection. We aimed to systematically review the diagnostic accuracy of CEA> 192 ng/mL in differentiating mucinous and non-mucinous PCNs and to determine the optimal cut-off value of CEA using individual patient data meta-analysis.

Methods:

A systematic literature search was performed in PubMed, EMBASE and the Cochrane Library for studies investigating the diagnostic accuracy of CEA> 192 ng/mL in differentiating mucinous and non-mucinous PCNs. Individual data of patients with (surgical) histological confirmation of the type of PCNs were extracted from the included studies to determine the optimal cut-off value of CEA.

Results:

Fourteen studies were included, with a total of 1088 patients. Meta-analysis showed that the pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of CEA> 192 ng/mL for the differentiation between mucinous and non-mucinous PCNs were: 67% (95% confidence interval (CI), 63%-70%); 76% (95% CI 71%-80%); 2.80 (95% CI 1.68 – 4.68); and 0.45 (95% CI 0.35 – 0.58), respectively. Individual data from seven studies with a total of 365 patients were extracted to determine the optimal cut-off value of CEA. A cut-off value of 20 ng/mL achieved the highest diagnostic accuracy for differentiating between mucinous and non-mucinous PCNs with pooled sensitivity of 91% (95% CI 88%-94%) and specificity of 85% (95% CI 72%-93%). With CEA> 20 ng/mL, 27 (7.4%) mucinous cysts would have been missed, whereas with a CEA> 192 ng/mL, 108 (29.6%) mucinous cyst would have been missed.

Conclusions:

Pancreatic cyst fluid CEA can accurately differentiate histologically verified mucinous from non-mucinous PCNs with an optimal cut-off value of 20 ng/mL