Background and Aims
Recently, low levels of intracystic glucose acquired with EUS-guided pancreatic cyst
fluid sampling have been shown to help to differentiate mucinous from nonmucinous
cystic neoplasms. The aim of this study was to perform a systematic review and meta-analysis
to evaluate the diagnostic characteristics of pancreatic cyst fluid glucose compared
with carcinoembryonic antigen (CEA) for pancreatic cystic lesions.
Methods
Individualized searches were developed in accordance with Preferred Reporting Items
for Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies
in Epidemiology guidelines and meta-analysis analyzed according to Cochrane Diagnostic
Test Accuracy working group methodology. A bivariate model was used to compute pooled
sensitivity and specificity, likelihood ratio, diagnostic odds ratio, and summary
receiver operating characteristics curve for intracystic glucose or CEA alone or combination
testing.
Results
Eight studies (609 lesions; mean patient age, 63.56 ± 2.75 years; 60.36% women) were
included. The pooled sensitivity for pancreatic cyst fluid glucose was significantly
higher compared with CEA alone (91% [95% confidence interval {CI}, 88-94; I2 = .00] vs 56% [95% CI, 46-66; I2 = 537.14]; P < .001) with no difference in specificity (86% [95% CI, 81-90; I2 = 24.16] vs 96% [95% CI, 90-99; I2 = 38.06]; P > .05). Diagnostic accuracy was significantly higher for pancreatic cyst fluid glucose
versus CEA alone (94% [95% CI, 91-96] vs 85% [95% CI, 82-88]; P < .001). Combination testing with pancreatic cyst fluid glucose and CEA did not improve
the diagnostic accuracy compared with glucose alone (97% [95% CI, 95-98] vs 94% [95%
CI, 91-96]; P > .05).
Conclusions
Low pancreatic cyst fluid glucose was associated with a high sensitivity and specificity
with significantly improved diagnostic accuracy compared with CEA alone for the diagnosis
of mucinous versus nonmucinous pancreatic cystic lesions.
Graphical abstract
Graphical Abstract
Abbreviations:
CEA (carcinoembryonic antigen), CI (confidence interval)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 05, 2021
Accepted:
April 27,
2021
Received:
March 15,
2021
Footnotes
DISCLOSURE: The following author disclosed financial relationships: T. Rustagi: Consultant for Boston Scientific and Cook Endoscopy. All other authors disclosed no financial relationships.
See CME section; p. 849.
Identification
Copyright
© 2021 by the American Society for Gastrointestinal Endoscopy
