The Presence of Mucin as a Predictor of Malignancy in Pancreatic Cystic Neoplasia

Objective: Characterization of pancreatic cystic neoplasms using EUS-guided FNA include molecular analysis of cystic aspirate, CEA level and fluid analysis for mucin. We prospectively analyzed the contribution of CEA and the presence of mucin as predictors of malignancy.

Methods: From January 2003 to October 2005, all patients referred to the University of Virginia with a cystic lesion of the pancreas underwent EUS-FNA for cytology, CEA level and mucin analysis. Data was collected prospectively and confirmed by final pathology. Univariate and multivariate analyses was performed on the following variables with regard to their ability to predict malignancy: age (<55 or ≥55 years, gender, solid component seen on EUS (yes vs. no), CEA level (below or above 300 ng/ml) and mucin presence (positive or negative). P value less than 0.05 was considered statistically significant.

Results: A total of 46 patients were included in this study, 19 males, 27 females with a mean age of 63±14 years (see table). The only complication was a patient who developed pancreatitis post procedure requiring PD stent placement. Univariate analysis identified the presence of a solid component, CEA level >300 ng/ml and the presence of mucin as a predictor of mucinous cystic neoplasia. Multivariate analysis confirmed CEA level above 300 ng/ml (p=0.011) and the presence of mucin (p=0.001) as significant predictors

Conclusion: In pancreatic cyst fluid analysis, the strongest predictor of malignancy is the presence of mucin followed by CEA level above 300 ng/ml. The work-up of cystic lesions of the pancreas should include EUS-FNA of the fluid for CEA level and mucin detection in conjunction with pathologic confirmation.

Cyst Type	No. of Pts	Age (yrs)	Gender	CEA ng/ml	Mucin
Serous	15	58	5 males	94	0%
Mucinous	12	63	4 males	3541	66%
Muc Cancer	5	67	2 males	21254	100%
IPMN	14	69	8 males	633	75%