Pancreatic cyst fluid examiantion

 CEA Levels:

 CEA >192 is 60% sensitive and 90% specific for mucinous cysts (ipmn/mcn)

This was based on a study of 70 lesions in 2004 and has stuck till date

 

CEA < 5 has excellent negative predictive value for mucinous cysts

 

CEA > 5, therefore can still be a mucinous neoplasm and needs to be taken in context.


Other markers such as Ca 72-4, CA 19-9, CA 15-3, CA 125 have lower accuracy than CEA




 

Amylase levels:

·      Amylase < 250 IU/L is highly unlikely to be connected to PD (eg  SCA)

·      MCN usually have very low / low amylase (one study suggested it has similar amylase to ipmn)



 

Glucose:

·      Glucose is very low in mucinous tumors & pseudocysts (those with communication to PD)– usually less than 2.8 mmol/l


    Glucose < 2.8 mmol/l has Sens/Spec of 90/90 (more accurate) compared to CEA >192 (sens/spec 60/90) for identification of mucinous cysts




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