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
Administrative Assistant
Gastrointestinal Unit
Massachusetts General Hospital
55 Fruit Street
Boston, MA, 02114
Phone: 617-724-3714
jaukstikalnis@partners.org
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 AukstikalnisAdministrative Assistant
Gastrointestinal Unit
Massachusetts General Hospital
55 Fruit Street
Boston, MA, 02114
Phone: 617-724-3714
jaukstikalnis@partners.org
DF/HCC Program Affiliation
Gastrointestinal MalignanciesResearch Abstract
Gastroenterology. 2004 May;126(5):1330-6. Related Articles, LinksDiagnosis 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.
