Role of Serial EUS-guided FNA on Pancreatic Cystic Neoplasms: A retrospective Analysis of Repeat Carcinoembryonic Antigen Measurements

Overview

Journal Gastrointest Endosc

Specialties Gastroenterology
Pharmacology
Radiology

Date 2016 Apr 10

PMID 27060712

Citations 6

Authors

Yousuke Nakai

Takuji Iwashita

Susumu Shinoura

Do H Park

Jason B Samarasena

John G Lee

Kenneth J Chang

Affiliations

Soon will be listed here.

Abstract

Background And Aims: Pancreatic cystic neoplasms (PCNs) often need interval surveillance, including repeat EUS, but the role of repeat FNA with fluid analysis is poorly defined. The aim of this analysis is to evaluate the potential clinical significance of serial carcinoembryonic antigen (CEA) measurements by EUS-guided FNA (EUS-FNA) in the surveillance for PCNs.

Patients: Patients who underwent EUS-FNA for PCNs were studied retrospectively. EUS-FNA findings were compared between index and prior procedures among patients who underwent repeat EUS-FNA.

Results: A total of 400 patients with PCNs underwent EUS-FNA. Eighty-seven of those patients had prior EUS-FNA with cyst fluid analysis. Patients with repeat FNA were significantly more likely to have multiple cysts (57% vs 41%; P = .008), multilocular cysts (75% vs 62%; P = .042), connection to pancreatic duct (33% vs 18%; P = .005), and higher initial CEA levels (94.8 vs 25.6 ng/mL; P = .003) compared with patients who had only a single FNA. A comparison of prior and index FNAs did not show significant differences in EUS or cyst fluid analysis findings. After log transformation, the association between CEA level at prior and index FNA was moderate (R = 0.626; P < .001), but cystic fluid CEA classification with a cutoff value of 192 ng/mL changed in 17 patients (20%), without significant changes in EUS findings.

Conclusions: Repeat surveillance EUS-FNA resulted in stable CEA levels in the majority of patients, with spurious fluctuations of CEA in approximately 20% of patients. These data call into question any clinical significance attributed to an isolated interval rise in CEA level, especially in light of a stable EUS examination.

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References

Springer S, Wang Y, Dal Molin M, Masica D, Jiao Y, Kinde I . A combination of molecular markers and clinical features improve the classification of pancreatic cysts. Gastroenterology. 2015; 149(6):1501-10. PMC: 4782782. DOI: 10.1053/j.gastro.2015.07.041. View

Ahmad N, Kochman M, Brensinger C, Brugge W, Faigel D, Gress F . Interobserver agreement among endosonographers for the diagnosis of neoplastic versus non-neoplastic pancreatic cystic lesions. Gastrointest Endosc. 2003; 58(1):59-64. DOI: 10.1067/mge.2003.298. View

Park W, Mascarenhas R, Palaez-Luna M, Smyrk T, OKane D, Clain J . Diagnostic performance of cyst fluid carcinoembryonic antigen and amylase in histologically confirmed pancreatic cysts. Pancreas. 2010; 40(1):42-5. PMC: 3005131. DOI: 10.1097/MPA.0b013e3181f69f36. View

Das A, Ngamruengphong S, Nagendra S, Chak A . Asymptomatic pancreatic cystic neoplasm: a cost-effectiveness analysis of different strategies of management. Gastrointest Endosc. 2009; 70(4):690-699.e6. DOI: 10.1016/j.gie.2009.02.013. View

Brugge W, Lewandrowski K, Lee-Lewandrowski E, Centeno B, Szydlo T, Regan S . Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology. 2004; 126(5):1330-6. DOI: 10.1053/j.gastro.2004.02.013. View

de Jong K, van Hooft J, Nio C, Gouma D, Dijkgraaf M, Bruno M . Accuracy of preoperative workup in a prospective series of surgically resected cystic pancreatic lesions. Scand J Gastroenterol. 2012; 47(8-9):1056-63. DOI: 10.3109/00365521.2012.674970. View

Nakai Y, Iwashita T, Park D, Samarasena J, Lee J, Chang K . Diagnosis of pancreatic cysts: EUS-guided, through-the-needle confocal laser-induced endomicroscopy and cystoscopy trial: DETECT study. Gastrointest Endosc. 2015; 81(5):1204-14. DOI: 10.1016/j.gie.2014.10.025. View

Yoon W, Daglilar E, Mino-Kenudson M, Morales-Oyarvide V, Pitman M, Brugge W . Characterization of epithelial subtypes of intraductal papillary mucinous neoplasm of the pancreas with endoscopic ultrasound and cyst fluid analysis. Endoscopy. 2014; 46(12):1071-7. DOI: 10.1055/s-0034-1377629. View

Nakai Y, Shinoura S, Ahluwalia A, Tarnawski A, Chang K . In vivo visualization of epidermal growth factor receptor and survivin expression in porcine pancreas using endoscopic ultrasound guided fine needle imaging with confocal laser-induced endomicroscopy. J Physiol Pharmacol. 2013; 63(6):577-80. View

10.

Cho C, Russ A, Loeffler A, Rettammel R, Oudheusden G, Winslow E . Preoperative classification of pancreatic cystic neoplasms: the clinical significance of diagnostic inaccuracy. Ann Surg Oncol. 2013; 20(9):3112-9. PMC: 4857772. DOI: 10.1245/s10434-013-2986-6. View

11.

Canto M, Hruban R . Managing pancreatic cysts: less is more?. Gastroenterology. 2015; 148(4):688-91. DOI: 10.1053/j.gastro.2015.02.033. View

12.

Nakai Y, Isayama H, Itoi T, Yamamoto N, Kogure H, Sasaki T . Role of endoscopic ultrasonography in pancreatic cystic neoplasms: where do we stand and where will we go?. Dig Endosc. 2013; 26(2):135-43. DOI: 10.1111/den.12202. View

13.

Konda V, Meining A, Jamil L, Giovannini M, Hwang J, Wallace M . A pilot study of in vivo identification of pancreatic cystic neoplasms with needle-based confocal laser endomicroscopy under endosonographic guidance. Endoscopy. 2013; 45(12):1006-13. DOI: 10.1055/s-0033-1344714. View

14.

Vege S, Ziring B, Jain R, Moayyedi P . American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015; 148(4):819-22. DOI: 10.1053/j.gastro.2015.01.015. View

15.

Klibansky D, Reid-Lombardo K, Gordon S, Gardner T . The clinical relevance of the increasing incidence of intraductal papillary mucinous neoplasm. Clin Gastroenterol Hepatol. 2012; 10(5):555-8. PMC: 3339400. DOI: 10.1016/j.cgh.2011.12.029. View

16.

Nakai Y, Isayama H, Shinoura S, Iwashita T, Samarasena J, Chang K . Confocal laser endomicroscopy in gastrointestinal and pancreatobiliary diseases. Dig Endosc. 2013; 26 Suppl 1:86-94. DOI: 10.1111/den.12152. View

17.

Gaddam S, Ge P, Keach J, Mullady D, Fukami N, Edmundowicz S . Suboptimal accuracy of carcinoembryonic antigen in differentiation of mucinous and nonmucinous pancreatic cysts: results of a large multicenter study. Gastrointest Endosc. 2015; 82(6):1060-9. DOI: 10.1016/j.gie.2015.04.040. View

18.

Furukawa T, Hatori T, Fujita I, Yamamoto M, Kobayashi M, Ohike N . Prognostic relevance of morphological types of intraductal papillary mucinous neoplasms of the pancreas. Gut. 2011; 60(4):509-16. DOI: 10.1136/gut.2010.210567. View

19.

Tanaka M, Fernandez-Del Castillo C, Adsay V, Chari S, Falconi M, Jang J . International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012; 12(3):183-97. DOI: 10.1016/j.pan.2012.04.004. View

20.

Weinberg B, Spiegel B, Tomlinson J, Farrell J . Asymptomatic pancreatic cystic neoplasms: maximizing survival and quality of life using Markov-based clinical nomograms. Gastroenterology. 2009; 138(2):531-40. PMC: 2949077. DOI: 10.1053/j.gastro.2009.10.001. View