Korean J Gastroenterol.  2002 Dec;40(6):394-401.

Cystic Fluid Analysis for the Differential Diagnosis of Pancreatic Cyst

• Woo SM
• Min BH
• Choi KD
• Kang JM
• Kim SJ
• Hwang JH
• Jeong JB
• Kim YT
• Yoon YB
• Park IA
• Han JK

Abstract

BACKGROUND/AIMS: Pancreatic cystic neoplasms (PCNs) comprise a pathologically heterogeneous group with many shared clinical features. Diagnostic methods to distinguish mucinous cystic tumors (MCTs) from other cysts are limited. We assessed the reliability of the cystic fluid analysis measuring CEA, CA19-9, and amylase, cytological analysis and mucin staining in the differential diagnosis of PCNs.
METHODS
Cystic fluid was obtained from 78 pancreatic cysts using fine needle aspiration. These lesions include 17 MCTs, 13 serous cystadenomas (SCAs), 5 solid pseudopapillary tumors (SPTs), 8 intraductal papillary mucinous tumors (IPMTs), 6 ductal carcinomas with cystic degeneration, and 29 pseudocysts.
RESULTS
Epithelial cells were observed in 27 (81%) of 33 PCNs, and cytological diagnosis was possible in 5 (31%) of 16 MCTs. Mucicarmine staining was positive only in 5 MCTs, one cystic adenocarcinoma and one IPMT but not in any cases of other cysts. CEA levels of cystic fluid more than 466 ng/mL had 86.7% sensitivity and 97.6% specificity for detecting MCTs. On the other hand, amylase levels over 479 U/dL had 72.7% sensitivity and 89.5% specificity for detecting pseudocysts.
CONCLUSIONS
Cystic fluid analysis measuring cytology, mucin staining, CEA and amylase levels is useful in the differential diagnosis of pancreatic cysts.

Keyword

Pancreatic cyst; Fine needle aspiration; Carcinoembryonic antigen; CA-19-9 antigen; Amylase

MeSH Terms

Adenocarcinoma
Amylases
Biopsy, Fine-Needle
CA-19-9 Antigen
Carcinoembryonic Antigen
Carcinoma, Ductal
Cystadenoma, Serous
Diagnosis
Diagnosis, Differential*
Epithelial Cells
Hand
Mucins
Pancreatic Cyst*
Pregnenolone Carbonitrile
Sensitivity and Specificity
Amylases
CA-19-9 Antigen
Carcinoembryonic Antigen
Mucins
Pregnenolone Carbonitrile