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HelpTest ID: CEAPC Carcinoembryonic Antigen (CEA), Pancreatic Cyst Fluid
Reporting Name
CEA, Pancreatic CystUseful 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 FluidOrdering Guidance
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: Sarstedt Aliquot Tube, 5 mL (T914)
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) Performed
Monday through Saturday
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 US Food and Drug Administration.CPT Code Information
82378
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| CEAPC | CEA, Pancreatic Cyst | 97747-0 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| CEAP | CEA, Pancreatic Cyst | 97747-0 |
| 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 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 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 [carbohydrate antigen] 19-9), and clinical findings for diagnosis.
Interpretation
A pancreatic cyst fluid carcinoembryonic antigen (CEA) concentration greater than or equal to 200 ng/mL 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 less than 5 ng/mL 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;126(5):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;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;113(4):464-479. doi:10.1038/ajg.2018.14
Report Available
1 to 3 daysMethod Name
Immunoenzymatic Assay
Forms
If not ordering electronically, complete, print, and send an Oncology Test Request (T729) with the specimen.
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