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Ibrahim Hakkı Köker,Nurcan Ünver,Fatma Ümit Malya,Ömer Uysal,Elmas Biberci Keskin,Hakan Şentürk 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.1
Background/Aims: The role of cyst fluid carcinoembryonic antigen (CEA) level in differentiating mucinous pancreatic cystic lesions(PCLs) is controversial. We investigated the role of cyst fluid CEA in differentiating low-risk (LR)-intraductal papillary mucinousneoplasms (IPMNs) from high-risk (HR)-IPMNs and LR-mucinous cystic neoplasms (MCNs). Methods: This was a retrospective study of 466 patients with PCLs who underwent endoscopic ultrasound-guided fine-needleaspirationover a 7-year period. On histology, low-grade dysplasia and intermediate-grade dysplasia were considered LR, whereashigh-grade dysplasia and invasive carcinoma were considered HR. Results: Data on cyst fluid CEA levels were available for 50/102 mucinous PCLs with definitive diagnoses. The median CEA (range)levels were significantly higher in HR cysts than in LR cysts (2,624 [0.5–266,510] ng/mL vs. 100 [16.8–53,445] ng/mL, p=0.0012). The area under the receiver operating characteristic curve (AUROC) was 0.930 (95% confidence interval [CI], 0.5–0.8; p<0.001) fordifferentiating LR-IPMNs from LR-MCNs. The AUROC was 0.921 (95% CI, 0.823–1.000; p<0.001) for differentiating LR-IPMNsfrom HR-IPMNs. Both had a CEA cutoff level of >100 ng/mL, with a negative predictive value (NPV) of 100%. Conclusions: Cyst fluid CEA levels significantly vary between LR-IPMNs, LR-MCNs, and HR-IPMNs. A CEA cutoff level of>100 ng/mL had a 100% NPV in differentiating LR-IPMNs from LR-MCNs and HR-IPMNs.