Comparative analysis of glucose and carcinoembryonic antigen in the diagnosis of pancreatic mucinous cysts: a systematic review and meta-analysis

  • Sandra Faias
    Correspondence
    Reprint requests: Sandra Faias, MD, Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE – Lisboa, Rua Prof Lima Basto, 1099-023 Lisboa, Portugal.
    Affiliations
    Department of Gastroenterology, Instituto Português de Oncologia de Lisboa de Francisco Gentil, EPE, Lisboa, Portugal

    Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal

    GRUBI-Grupo de Revisões Sistemáticas, Universidade da Beira Interior, Covilhã, Portugal
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  • Marília Cravo
    Affiliations
    Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal

    Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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  • Paula Chaves
    Affiliations
    Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal

    Department of Pathology, Instituto Português de Oncologia de Lisboa de Francisco Gentil, EPE, Lisboa, Portugal
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  • Luisa Pereira
    Affiliations
    GRUBI-Grupo de Revisões Sistemáticas, Universidade da Beira Interior, Covilhã, Portugal

    Centro de Matemática e Aplicações (CMA-UBI), Universidade da Beira Interior, Covilhã, Portugal
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Published:April 10, 2021DOI:https://doi.org/10.1016/j.gie.2021.03.935

      Background and aims

      Pancreatic cystic fluid (PCF) analysis is useful to distinguish between different cyst types and to guide management. The aim of our study was to compare the diagnostic accuracy of glucose level with carcinoembryonic antigen (CEA) in PCF for mucinous cyst diagnosis.

      Methods

      We identified studies with PCF obtained by EUS before surgery, with cysts classified as mucinous and nonmucinous according to surgical specimens. A random-effects model was used for quantitative meta-analysis. Pooled sensitivities, specificities, and summary receiver operating characteristic (ROC) curve analysis were conducted.

      Results

      For CEA, we included 31 studies with 5268 patients, of which 2083 were referred for surgery. For glucose, we included 4 studies with 345 patients, of which 275 were referred for surgery. Glucose performed better than CEA for mucinous cysts diagnosis (premalignant and malignant) with sensitivities of .90 (95% confidence interval [CI], .85-.94) and .67 (95% CI, .65-.70), specificities of .82 (95% CI, .72-.89) and .80 (95% CI, 0.76-0.83), and areas under the ROC curve of .96 and .79, respectively. Glucose had a higher sensitivity (90%), with uncommon false-negative results, making it an excellent biomarker to exclude a mucinous cyst. Sensitivity analysis demonstrated that the findings of the current meta-analysis are robust.

      Conclusion

      Glucose level in PCF is more accurate than CEA for preoperative diagnosis of mucinous cysts. It may become a useful first-line test, particularly in small cysts with a limited volume of PCF. Larger studies are awaited to confirm glucose as the single test for mucinous cyst diagnosis.

      Abbreviations:

      AUC (area under the curve), CEA (carcinoembryonic antigen), CI (confidence interval), PCF (pancreatic cystic fluid), PCL (pancreatic cystic lesion), ROC (receiver operating characteristic)
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      Linked Article

      • Comparison of pancreatic cystic fluid glucose and carcinoembryonic antigen in the diagnosis of pancreatic mucinous cysts
        Gastrointestinal EndoscopyVol. 94Issue 1
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          We read with interest “A comparative analysis of glucose and carcinoembryonic antigen in diagnosis of pancreatic mucinous cysts: a systematic review and meta-analysis” by Faias et al.1 The authors conclude that pancreatic cyst fluid (PCF) glucose is more accurate than carcinoembryonic antigen (CEA) in determining whether the lesion is mucinous. There are several limitations in the reviewed body of literature that make this conclusion suspect. One of the 5 studies did not compare glucose with surgical pathologic analysis and should not have been included in the meta-analysis, given the inclusion criteria set by the authors.
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