Cyst fluid glucose: An alternative to carcinoembryonic antigen for pancreatic mucinous cysts

Table 1 Differential diagnosis of pancreatic cystic lesions

	IPMN	MCN	PC	SCN	NET	SPN
Sex	M = F	F > M	M > F	F > M	M = F	F > M
Age (yr)	40-80	30-70	Variable	50-70	20-50	8-40
Clinical setting	Asymptomatic Pancreatitis	Asymptomatic Pain/mass	Pancreatitis	Asymptomatic Pain/mass	Asymptomatic Pain/mass	Asymptomatic Pain/mass
Appearance	Dilated MPD and/or branch-ducts. Fish- mouth papilla.	Well-circumscribed macrocystic lesion	Unilocular. Thin/thick- walled. Acute/chronic pancreatitis.	Microcystic with central fibrosis/ macrocystic and solid variants are possible	Associated mass	Mixed solid and cystic with well-defined borders.
Location	Head	Body/tail	Anywhere	Anywhere	Body/tail	Body/tail
Communication with MPD	Yes	Rare	Yes/no	No	No	No
Calcification	No	Peripheral	Related to chronic pancreatitis	Central	In necrotic lesions.	In necrotic lesions.
Fluid	Clear/viscous	Clear/viscous	Thin/dark	Clear/watery	Thin	Bloody
Epithelium	Columnar papillary mucinous.	Columnar/cuboidal mucinous.	No epithelium. Inflammatory cells.	Serous cuboidal. Stain for glycogen.	Endocrine. Stain for synaptophysin, chromogranin	Stain for vimentin, α1-antitrypsin, β-catenin
Malignant potential	High	High	None	Rare	Low	Low
Cyst fluid CEA	Usually High	High	Low	Very low	Very low	Low
Cyst fluid amilase	High	Variable	High	Low	Low	Low

IPMN: Intraductal papillary mucinous neoplasm; MCN: Mucinous cystic neoplasm; PC: Pseudocyst; SCN: Serous cystic neoplasm; NET: Neuroendocrine tumor; SPN: Solid pseudopapillary neoplasm; MPD: Main pancreatic duct; CEA: Carcinoembryonic antigen.

Table 2 Comparison between cyst fluid carcinoembryonic antigen and glucose levels, using a carcinoembryonic antigen cut-off suggestive of mucinous cystic neoplasms

Glucose levelsCEA levels	< 50 mg/dL	≥ 50 mg/dL	Total
≥ 192 ng/mL	33	3	36a
< 192 ng/mL	25	54	79
Total	58	57	115

CEA: Carcinoembryonic antigen;

^aP < 0.0001.

Table 3 Comparison between cyst fluid carcinoembryonic antigen and glucose levels, using a carcinoembryonic antigen cut-off suggestive of serous cystic neoplasms

Glucose levelsCEA levels	< 50 mg/dL	≥ 50 mg/dL	Total
≥ 5 ng/mL	55	9	64a
< 5 ng/mL	3	48	51
Total	58	57	115

CEA: Carcinoembryonic antigen;

^aP < 0.0001.