Carcinoembryonic antigen assay in fine needle aspirate of pancreas: a diagnostic adjunct to cytology.

Carcinoembryonic antigen (CEA) was measured in 21 consecutive fine needle aspirates (FNA) of solid pancreatic lesions from 20 patients to determine whether elevated levels would predict the presence of pancreatic carcinoma in cytologically negative aspirates. Final diagnoses were correlated with clinical, radiologic, and pathologic (four patients) findings and follow-up. Twenty aspirates had malignancy, and one was benign. FNAs were performed under radiologic guidance with a 22-gauge Chiba needle and a 20-ml syringe. Cytologic examination was rendered on Papanicolaou-stained slides and, when available, hematoxylin and eosin-stained cell blocks. CEA was measured by enzyme immunoassay (Abbott Laboratories). Sensitivity of cytologic diagnosis was 80%; specificity was 100%. With 5 ng/ml as cutoff, the sensitivity of CEA for malignancy was 70% and for adenocarcinoma of pancreas, 78%; the specificity was 100%. The mean CEA in pancreatic carcinoma was 152.1 ng/ml (range 1.4 to greater than 880 ng/ml). The mean CEA for lymphoma, metastatic lung carcinoma, and benign aspirate was 1.0 ng/ml. Elevated CEA was diagnostic of pancreatic carcinoma in three cytologically negative aspirates. Combined sensitivity of CEA and cytology was 95%. Elevated CEA in FNA of pancreas increases the sensitivity of cytologic diagnosis and may suggest carcinoma in cytologically negative aspirates.