Intraductal Papillary Mucinous Neoplasms of the Pancreas: Performance of Pancreatic Fluid Analysis for Positive Diagnosis and the Prediction of Malignancy View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2008-09-04

AUTHORS

Frédérique Maire, Hélène Voitot, Alain Aubert, Laurent Palazzo, Dermot O'Toole, Anne Couvelard, Philippe Levy, Michel Vidaud, Alain Sauvanet, Philippe Ruszniewski, Pascal Hammel

ABSTRACT

INTRODUCTION: The preoperative diagnosis of intraductal papillary mucinous neoplasms (IPMN) of the pancreas must be as reliable as possible because large or even total pancreatectomy may be necessary. Early diagnosis of malignant forms is important to improve prognosis. The diagnostic accuracy of fluid analysis using endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been confirmed in cystic lesions of the pancreas. It is not known if these results can be applied to IPMN. AIMS: To determine the levels of biochemical and tumor markers in fluid from EUS-FNA in patients with IPMN and to assess the impact on the diagnosis of IPMN. PATIENTS AND METHODS: In total, 41 patients (14 men, median age 64 yr) underwent EUS-FNA before surgical resection of IPMN in our center. Levels of amylase, lipase, carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19.9, and CA 72.4 were measured in the cyst fluid. The performance of the markers was retrospectively evaluated for: (a) a positive diagnosis of IPMN, using cutoffs validated in the literature for mucinous pancreatic lesions and (b) an assessment of malignancy (i.e., high-grade dysplasia or invasive carcinoma) compared with the final pathological examination of the surgical specimen. RESULTS: EUS-FNA was performed in dilated branch ducts (BD) in 39 cases and in the main pancreatic duct in 2 cases. No serious complications occurred. The median fluid levels of amylase, lipase, CEA, CA 19.9, and CA 72.4 were 20,155 U/mL, 59,500 U/mL, 173 ng/mL, 6,400 U/mL, and 11.5 U/mL, respectively. A CEA level >200 ng/mL and a CA 72.4 >40 U/mL had a 44% and a 39% sensitivity, respectively, for the diagnosis of IPMN. The levels of CEA, CA 19.9, and CA 72.4 were significantly different between benign and malignant IPMN. The sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) of a CEA level >200 ng/mL for the diagnosis of malignant IPMN were 90%, 71%, 50%, and 96%, respectively. The sensitivity, specificity, PPV, and NPV of a CA 72.4 level >40 U/mL for this purpose were 87.5%, 73%, 47%, and 96%, respectively. CONCLUSION: CEA and CA 72.4 in pancreatic cyst fluid have excellent NPVs in the preoperative differential diagnosis of benign versus malignant IPMN, and might reinforce the decision of not to operate on patients with BD-type without predictive factors of malignancy. More... »

PAGES

ajg2008572

Identifiers

URI

http://scigraph.springernature.com/pub.10.1111/j.1572-0241.2008.02114.x

DOI

http://dx.doi.org/10.1111/j.1572-0241.2008.02114.x

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1008288553

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/18775021


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62 levels of CEA
63 levels of amylase
64 lipase
65 literature
66 mL
67 main pancreatic duct
68 malignancy
69 malignant form
70 malignant intraductal papillary mucinous neoplasm
71 markers
72 method
73 mucinous neoplasms
74 negative predictive value
75 neoplasms
76 pancreas
77 pancreatectomy
78 pancreatic cyst fluid
79 pancreatic duct
80 pancreatic lesions
81 papillary mucinous neoplasm
82 pathological examination
83 patients
84 performance
85 positive diagnosis
86 prediction
87 prediction of malignancy
88 predictive factors
89 predictive value
90 preoperative diagnosis
91 preoperative differential diagnosis
92 prognosis
93 purpose
94 resection
95 results
96 sensitivity
97 serious complications
98 specificity
99 specimen
100 surgical resection
101 surgical specimen
102 total pancreatectomy
103 tumor markers
104 ultrasonography-guided fine-needle aspiration
105 values
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