The Endoscopic Ultrasonography and Fine Needle Aspiration Agreement in Patients with Pancreatic Cystic Lesions, in Tehran, Iran.

Background: IThis study aimed to investigate the concordance of endoscopic ultrasonography (EUS) results and biochemical analysis of cyst fluid obtained through fine needle aspiration (FNA) in diagnosing mucinous pancreatic cysts. Methods: In this retrospective study, the medical records of 81 patients with pancreatic cystic lesions were examined. EUS results and cyst fluid analysis (carcinoembryonic antigen [CEA] and amylase) concordance rate was evaluated, and the agreement between the two methods was assessed through Cohen's kappa coefficient. Results: The concordance rate of EUS and cyst fluid analysis with CEA cutoff point>192 ng/mL was 52.5% and 69.2%, respectively, for mucinous cystic neoplasm (MCN) and Intraductal papillary mucinous neoplasm (IPMN) diagnosis. The sensitivity and specificity of cyst fluid analysis for MCN and IPMN (taking EUS as the reference) were 59.1% and 93.33%, respectively. The positive predictive value was equal to 97.5%, and its negative predictive value was 34.14. Using the CEA<5 ng/mL cutoff point for detecting serous cystic neoplasm (SCN) cysts was associated with the sensitivity, specificity, and positive and negative predictive values of 73.3%, 78.8%, 44%, and 92.8%, respectively. The concordance rate of EUS and pancreatic cyst fluid analysis was 65.43%, with a kappa correlation coefficient of 0.326. Conclusion: The specificity and positive predictive value of CEA>192 for the diagnosis of mucinous pancreatic cysts is high, but it is associated with moderate sensitivity and a low negative predictive value. Altogether, there is a moderate agreement between the results of EUS and biochemical analysis of FNA cyst fluid in diagnosing mucinous pancreatic cysts.