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William R. Brugge, MD

Professor, Department of Medicine, Harvard Medical School

Director, GI endoscopy Unit, Massachusetts General Hospital

Contact Info

William Brugge
Massachusetts General Hospital
55 Fruit Street
Boston, MA, 02114
Mailstop: GI Unit/Blake 4
Phone: 617-724-3715
Fax: 617-724-5997
wbrugge@partners.org

Assistant

Judy Aukstikalnis
Administrative Assistant
Gastrointestinal Unit
Massachusetts General Hospital
55 Fruit Street
Boston, MA, 02114
Phone: 617-724-3714
jaukstikalnis@partners.org

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.

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