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Optimal carcinoembryonic antigen (CEA) cutoff values in the diagnosis of neoplastic mucinous pancreatic cysts differ among assays
  1. David Kim1,
  2. Elizabeth Margolskee2,
  3. Abha Goyal3,
  4. Momin T Siddiqui3,
  5. Jonas J Heymann3,
  6. Rema Rao4,
  7. Joshua Hayden5
  1. 1Department of Pathology & Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  2. 2Department of Pathology & Laboratory Medicine, Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  3. 3Department of Pathology & Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
  4. 4Department of Pathology & Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
  5. 5Department of Chemistry, Norton Healthcare, Louisville, Kentucky, USA
  1. Correspondence to Dr David Kim, Department of Pathology & Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York NY 10065, USA; kimd8{at}mskcc.org

Abstract

Aim Pancreatic cyst fluid carcinoembryonic antigen (CEA) is a pivotal test in the diagnosis and management of neoplastic mucinous cysts (NMC) of the pancreas. Cyst fluid CEA levels of 192 ng/mL have been widely used to identify NMC. However, CEA values are unique to and significantly differ between individual assays with various optimal cutoffs reported in the literature for NMC. Here, we investigate the optimal CEA cut-off value of pancreatic cysts from two different assays to identify differences in thresholds.

Methods Pancreatic cyst fluid CEA levels, CEA assay platform (Beckman Dxl (BD) or Siemens Centaur XP (SC)), and clinical/pathological information were retrospectively collected. Cases were categorised into either NMC or non-NMC. Optimal CEA cut-off values were calculated via a receiver operator characteristic curve. Cut-off values were then identified separately by assay platform.

Results In total, 149 pancreatic cystic lesions with concurrent CEA values (SC: n=47; BD: n=102) were included. Histological correlation was available for 26 (17%) samples. The optimal CEA cut-off value for all samples at the study institution was 45.9 ng/mL (area under the curve (AUC)=86, Sn=85.7%, Sp=73.8%). When analysed separately by CEA assay, the cut-off values were 45.9 ng/mL (AUC=84.27, Sn=89.7%, Sp=71.4%) for BD and 24.4 ng/mL (AUC=77, Sn=81.8%, Sp=75%) for SC (p=0.48).

Conclusions This study showed an optimal pancreas cyst CEA cut-off threshold of 45.9 ng/mL, which is lower than commonly cited literature with different cutoffs on the two separate platforms (BD: 45.9 ng/mL, SC: 24.4 ng/mL).

  • CYTOLOGY
  • Pancreatic Neoplasms
  • Biomarkers, Tumor

Data availability statement

Data are available upon reasonable request. Data analysed for this study are available from the corresponding author on reasonable request.

https://doi.org/10.1136/jcp-2023-209136

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    Data availability statement

    Data are available upon reasonable request. Data analysed for this study are available from the corresponding author on reasonable request.

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    Footnotes

    • RR and JH are joint senior authors.

    • Handling editor Yoh Zen.

    • Twitter @Raodyisms

    • Contributors All authors of this article declare that we qualify for authorship for this manuscript. Each author has participated sufficiently in the work and takes public responsibility for appropriate portions of the content of this article. DK and RR carried out background research and drafted the manuscript. DK, JH and RR conceived the idea for the manuscript, its design and coordination. EM and DK performed the statistical analysis for this study. All authors reviewed the manuscript critically for important intellectual content. All authors read and approved the final manuscript. DK is the guarantor for this manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.