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Test ID: CEAPC Carcinoembryonic Antigen (CEA), Pancreatic Cyst Fluid

Reporting Name

CEA, Pancreatic Cyst

Useful For

When used in conjunction with imaging studies, cytology, and other pancreatic cyst fluid tumor markers:

-Distinguishing between mucinous and nonmucinous pancreatic cysts

-Determining the likely type of malignant pancreatic cyst

Specimen Type

Pancreatic Cyst Fluid


Advisory Information


This test should not be ordered for pancreatic fluid of noncyst origin (eg, pancreatic duct fluid; peripancreatic fluid) since reference values have not been established for this specimen type. For ordering assistance call 800-533-1710.



Specimen Required


Supplies: Aliquot Tube, 5 mL (T465)

Container/Tube: Plain, plastic, screw-top tube

Specimen Volume: 1 mL


Specimen Minimum Volume

0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Pancreatic Cyst Fluid Frozen (preferred) 90 days
  Refrigerated  72 hours
  Ambient  24 hours

Reference Values

An interpretive report will be provided.

Day(s) and Time(s) Performed

Monday through Saturday; Varies

Test Classification

This test has been modified from the manufacturer's instructions. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information

82378

LOINC Code Information

Test ID Test Order Name Order LOINC Value
CEAPC CEA, Pancreatic Cyst 12515-3

 

Result ID Test Result Name Result LOINC Value
CEAP CEA, Pancreatic Cyst 12515-3
SITE6 Site 39111-0

Clinical Information

Cystic lesions of the pancreas are of various types including:

-Benign cysts:

 -Inflammatory cysts (pseudocysts)

 -Serous cysts (serous cystadenoma)

 

-Mucinous cysts:

 -Premalignant (mucinous cystadenoma)

 -Malignant (cystadenocarcinoma, intrapapillary mucinous neoplasia)

 

The diagnosis of pancreatic cyst type is often difficult and may require correlating imaging studies with results of cytological examination and tumor marker testing performed on cyst aspirates. Various tumor markers have been evaluated to distinguish non-mucinous, nonmalignant pancreatic cysts from mucinous cysts, which have a high likelihood of malignancy. Carcinoembryonic antigen (CEA) has been found to be the most reliable tumor marker for identifying those pancreatic cysts that are likely mucinous. In cyst aspirates, CEA concentrations of 200 ng/mL and above are highly suspicious for mucinous cysts. The greater the CEA concentration, the greater the likelihood that the mucinous cyst is malignant. However, CEA testing does not reliably distinguish between benign, premalignant, or malignant mucinous cysts. CEA test results should be correlated with the results of imaging studies, cytology, other cyst fluid tumor markers (ie, amylase and CA 19-9), and clinical findings for diagnosis.

Interpretation

A pancreatic cyst fluid carcinoembryonic antigen (CEA) concentration of 200 ng/mL and higher is very suggestive for a mucinous cyst but is not diagnostic. The sensitivity and specificity for mucinous lesions are approximately 62% and 93%, respectively, at this concentration. Cyst fluid CEA concentrations of 5 ng/mL and below indicate a low risk for a mucinous cyst, and are more consistent with serous cystadenoma, fluid collections complicating pancreatitis, cystic neuroendocrine tumor, or metastatic lesions. CEA values between these extremes have limited diagnostic value.

Clinical Reference

1. Brugge WR, Lewandrowski K, Lee-Lewandrowski E, et al: Diagnosis of pancreatic cystic neoplasms: a report of cooperative pancreatic cyst study. Gastroenterology. 2004 May;126:1330-1336

2. Snozek CL, Jenkins SM, Bryant SC, et al: Analysis of CEA, CA 19-9, and amylase in pancreatic cyst fluid for diagnosis of pancreatic lesions. Clin Chem. 2008;54(Suppl S):A126-127

3. Khalid A, Brugge W: ACG practice guidelines for the diagnosis and management of neoplastic pancreatic cysts. Am J Gastroenterol. 2007 Oct;102(10):2339-2349

4. Elta GH, Enestvedt BK, Sauer BG, Lennon AM: ACG clinical guideline: diagnosis and management of pancreatic cysts. Am J Gastroenterol. 2018 Apr;113(4):464-479. doi: 10.1038/ajg.2018.14

Analytic Time

Same day/1 day

Method Name

Immunoenzymatic Assay

Mayo Clinic Laboratories | Gastroenterology Catalog Additional Information:

mml-gi-pancreas-cancer