Utility of endoscopic ultrasound, cytology and fluid carcinoembryonic antigen and CA 19-9 levels in pancreatic cystic lesions

Table 1 Patient and cyst characteristics n (%)

	Entire group(n = 41)	Benign(n = 23)	Malignant/pre-malignant(n = 18)	Pvalues1
Age (mean, yr)	56	62	51	0.03
Male	12 (29)	5 (22)	7 (39)	0.4
Symptoms
Abdominal pain	26 (63)	12 (52)	13 (72)	0.3
Other symptoms	5 (12)	4 (17)	2 (11)	0.9
Asymptomatic	10 (24)	7 (30)	3 (17)	0.6
Pancreatitis
Previous acute pancreatitis	9 (22)	7 (30)	2 (11)	0.3
Chronic pancreatitis	8 (20)	5 (22)	3 (17)	0.9
Cyst diameter
< 1 cm	3 (7)	3 (13)	0 (0)	0.3
1-1.9 cm	7 (17)	5 (22)	2 (11)	0.6
2.0-5 cm	18 (44)	9 (39)	8 (44)	0.9
> 5 cm	13 (32)	5 (22)	8 (44)	0.2
Mean (cm)	3.0	3.4	5.6	0.006
Location
Head	13 (32)	9 (39)	4 (22)	0.4
Uncinate	3 (7)	1 (4)	2 (11)	0.8
Body	14 (34)	7 (30)	7 (39)	0.8
Tail	11 (27)	5 (22)	5 (28)	0.9
Investigations
Surgery	23 (56)	8 (35)	14 (78)	0.02
Cytology	41 (100)	23 (100)	17 (94)	0.8
CEA	23 (56)	12 (52)	11 (61)	0.8
CA 19-9	22 (54)	10 (44)	12 (67)	0.2
EUS	26 (63)	13 (57)	9 (39)	0.4

¹Comparison between benign and malignant/premalignant columns.

Table 2 Diagnostic performance of EUS, cytology, CEA and CA 19-9 fluid levels in identifying premalignant of malignant cystic lesions mean 95% CI (%)

	EUS alone	Cytology	CEA > 3.1 ng/mL1	CA 19-9 > 37 U/mL1
Sensitivity	50 (16-84)	71 (49-92)	70 (42-98)	75 (33-75)
Specificity	56 (30-80)	96 (87-99)	85 (65-99)	90 (71-99)
Negative predictive value	69 (39-91)	82 (62-94)	79 (57-99)	75 (43-95)
Positive predictive value	36 (11-69)	92 (64-99.8)	78 (51-99)	90 (56-99.8)
Accuracy	54 (34-74)	85 (74-96)	78 (61-95)	82 (66-98)
Area under curve	0.53 (0.32-0.74)	0.83 (0.68-0.93)	0.78 (0.54-0.93)	0.8 (0.57-0.94)

¹Optimal cut-offs for CEA and CA 19-9 as determined by receiver-operator characteristic (ROC) curve analysis.