DF/HCC Program Affiliation

Gastrointestinal Malignancies

Research Abstract

Gastroenterology. 2004 May;126(5):1330-6. Related Articles, Links

Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study.

Brugge WR, Lewandrowski K, Lee-Lewandrowski E, Centeno BA, Szydlo T, Regan S, del Castillo CF, Warshaw AL.

Gastrointestinal Unit, Department of Surgery, Massachusetts General Hospital, Blake 4, 55 Fruit Street, Boston, MA 02114, USA. Wbrugge@partners.org

BACKGROUND & AIMS: Cysts of the pancreas display a wide spectrum of histology, including inflammatory (pseudocysts), benign (serous), premalignant (mucinous), and malignant (mucinous) lesions. Endoscopic ultrasonography (EUS) may offer a diagnostic tool through the combination of imaging and guided, fine-needle aspiration (FNA). The purpose of this investigation was to determine the most accurate test for differentiating mucinous from nonmucinous cystic lesions. METHODS: The results of EUS imaging, cyst fluid cytology, and cyst fluid tumor markers (CEA, CA 72-4, CA 125, CA 19-9, and CA 15-3) were prospectively collected and compared in a multicenter study using histology as the final diagnostic standard. RESULTS: Three hundred forty-one (341) patients underwent EUS and FNA of a pancreatic cystic lesion; 112 of these patients underwent surgical resection, providing a histologic diagnosis of the cystic lesion (68 mucinous, 7 serous, 27 inflammatory, 5 endocrine, and 5 other). Receiver operator curve analysis of the tumor markers demonstrated that cyst fluid CEA (optimal cutoff of 192 ng/mL) demonstrated the greatest area under the curve (0.79) for differentiating mucinous vs. nonmucinous cystic lesions. The accuracy of CEA (88 of 111, 79%) was significantly greater than the accuracy of EUS morphology (57 of 112, 51%) or cytology (64 of 109, 59%) (P < 0.05). There was no combination of tests that provided greater accuracy than CEA alone (P < 0.0001). CONCLUSIONS: Of tested markers, cyst fluid CEA is the most accurate test available for the diagnosis of mucinous cystic lesions of the pancreas.

Publications

• Brugge WR, Lauwers GY, Sahani D, Fernandez-del Castillo C, Warshaw AL.Cystic neoplasms of the pancreas.N Engl J Med 2004 Sep 16;351(12):1218-26.
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• Brugge WR, Lewandrowski K, Lee-Lewandrowski E, Centeno BA, Szydlo T, Regan S, del Castillo CF, Warshaw AL.Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study.Gastroenterology 2004 May;126(5):1330-6.
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• Brugge WR.Evaluation of pancreatic cystic lesions with EUS.Gastrointest Endosc 2004 May;59(6):698-707.
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• Brugge WR, Mueller PR, Misdraji J.Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 8-2004. A 28-year-old man with abdominal pain, fever, and a mass in the region of the pancreas.N Engl J Med 2004 Mar 11;350(11
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• Warshaw AL, Brugge WR, Lewandrowski KB, Pitman MB.Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 35-2003. A 75-year-old man with a cystic lesion of the pancreas.N Engl J Med 2003 Nov 13;349(20):1954-61.
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