EVALUATION OF CYST FLUID ANALYSIS IN THE DIAGNOSIS OF PANCREATIC CYSTS

The pre-operative differential diagnosis of pancreatic cystic lesions is often difficult because of the lack of reliable clinical or radiolo gical criteria, In order to improve the pre-operative recognition of t hese lesions, we performed cyst fluid analysis for enzymes (amylase an d lipase), tumour markers (CEA, CA 19-9, CA 125, CA 72-4), and cytolog y in 52 pancreatic cysts, The cases included 21 pseudocysts, 12 mucino us cystic neoplasms, 7 ductal carcinomas, 7 benign lesions, and 5 rare malignancies observed from 1989 to 1994. Cyst fluid amylase, lipase, CEA, and CA 19-9 were variable and not discriminant between the groups . CA 125 fluid levels were high in 63% of malignant cysts, CA 724 flui d levels were significantly higher in mucinous cystic tumours than in pseudocysts (p<0.0001), showing 95% specificity in detecting mucinous or malignant cysts. Cytology showed a sensitivity of 61% and a specifi city of 100%, CA 72-4 determination raised the sensitivity of cytology to 92% in detecting mucinous or malignant cysts, This study confirms the low sensitivity of cytologic examination and low amylase specifici ty in distinguishing cystic neoplasms from pseudocysts, Cyst tumour ma rkers assay is useful to improve the sensitivity of cytology, and CA 7 2-4 shows the best specificity in detecting (pre)malignant neoplasms.