[1565] Pancreatic Cyst Fluid Carcinoembryonic Antigen (CEA) Level Obtained by Endoscopic Ultrasound Guided-Fine Needle Aspiration (EUS-FNA) Does Not Predict Grade of Dysplasia in Intraductal Papillary Mucinous Neoplasm (IPMN) of the Pancreas.

Curtis McCarty, Jason Klapman, Mokenge Malafa, Jill Weber, Domenico Coppola, Barbara A Centeno. Moffitt Cancer Center, Tampa, FL

Background: Measurement of the CEA level is the most consistently used ancillary study in pancreatic cyst fluids obtained by fine needle aspiration. A level of 192 ng/ml has been reported as an accurate cut-off value for the distinction of mucinous vs. nonmucinous lesions. More controversial is whether the level of CEA can be used to predict the grade of dysplasia in a cyst suspected of being IPMN, and thus guide surgical management. The aim of this study is to determine whether the CEA level predicts the grade of dysplasia in patients with surgically resected IPMN.
Design: Patients were identified by searching an IRB approved database of patients with IPMN at the Moffitt Cancer Center. Patients with a resected IPMN were selected for this study if they had previously undergone EUS-FNA of the cystic mass with CEA measurement of the cyst fluid. All resection specimens were reviewed by two pathologists (CM and BAC) to confirm the pathological diagnosis. IPMN were classified into low grade dysplasia (LG), moderate dysplasia (MD), high grade dysplasia (HG) or invasive carcinoma (INV). One-way ANOVA was performed to examine the differences of CEA levels among pathologic groups.
Results: We identified 47 patients who met these criteria (35 males, 12 females). There were 9 LG, 17 MD, 14 HG and 7 INV. The fluid CEA levels and corresponding surgical pathologic diagnoses are summarized in Table 1.

Table 1: Fluid CEA Levels and Corresponding Surgical Pathologic Diagnoses
Resection Specimen DiagnosisCEA Ranges, ng/mlCEA Mean Values, ng/mlCEA Median Values, ng/ml
LG (N=9)37.9-45411257458
MD (N=17)8.5- 90,1007171201
HG (N=14)47.2- 136,44110806292.5
INV (N=7)140- 1866443200

The mean level of CEA increased from LG to HG. INV showed CEA levels markedly lower than those in LG. ANOVA statistical analysis showed no significant difference among pathological diagnoses (p = 0.72).
Conclusions: This retrospective study shows no statistical significance in the CEA levels among the pathologic groups. Furthermore, not only is a markedly elevated cyst fluid CEA not an accurate predictor of HG or INV, the appearance of INV in IPMN is associated with a decline in mean CEA. Therefore, the decision to observe or resect a pancreatic neoplastic mucinous cyst suspected of being IPMN should not be based on the CEA level.
Category: Liver & Pancreas

Tuesday, March 1, 2011 1:00 PM

Poster Session IV # 199, Tuesday Afternoon


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