Cyst carcinoembryonic antigen in differentiating pancreatic cysts: A meta-analysis

Saowanee Ngamruengphong, Michael J. Bartel, Massimo Raimondo

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


Background: Using carcinoembryonic antigen in discriminating between benign and malignant disease remains controversial. Aims: We aim to evaluate the diagnostic accuracy of cyst fluid carcinoembryonic antigen in predicting malignant pancreatic cystic lesions. Methods: We performed a literature search of MEDLINE and EMBASE. We included studies that compared the diagnostic accuracy of carcinoembryonic antigen with histology. Pooled estimates of diagnostic precision were calculated using random-effects models. Results: Eight studies (504 patients) were included. The carcinoembryonic antigen cutoff level for determining a malignant cyst ranged from 109.9 to 6000. ng/mL. Pooled estimates of carcinoembryonic antigen in malignant cysts prediction were poor: pooled sensitivity of 63%, pooled specificity of 63%. The positive likelihood ratio was 1.89 and the negative likelihood ratio was 0.62. The diagnostic odds ratio was 3.84. The area under the summary receiver-operating characteristic curve was 0.70. In subgroup analysis of patients with mucinous cysts (mucinous cystic neoplasm and intraductal papillary mucinous neoplasm; 5 studies, 227 patients), pooled sensitivity was 65%, pooled specificity 66% and diagnostic odds ratio 4.74 respectively. Conclusion: This meta-analysis suggests that the accuracy of carcinoembryonic antigen in differentiating "between benign and malignant" pancreatic cysts was poor. The decision to perform surgical resection for pancreatic cystic lesions should not be based solely on carcinoembryonic antigen level.

Original languageEnglish (US)
Pages (from-to)920-926
Number of pages7
JournalDigestive and Liver Disease
Issue number11
StatePublished - Nov 2013


  • Endoscopic ultrasonography
  • Fine-needle aspiration
  • Pancreatic cancer

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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