Pancreatic juice CEA during SPACE for pancreatic duct stenosis: diagnostic and exploratory risk stratification value.

Authors

Tetsuya Okuwaki, Shinichi Takano, Satoshi Kawakami, Natsuhiko Kuratomi, Dai Yoshimura, Koji Yamashita, Makoto Kadokura, Mitsuharu Fukasawa, Hiroko Shindo, Shinya Maekawa, Nobuyuki Enomoto, Atsunori Tsuchiya

Published in

Clinical journal of gastroenterology. Jul 06, 2026. Epub Jul 06, 2026.

Abstract

This study evaluated whether pancreatic juice carcinoembryonic antigen (PJ-CEA) measurement during serial pancreatic juice aspiration cytologic examination (SPACE) enhanced diagnostic accuracy and was associated with subsequent pancreatic cancer (PC) diagnosis, especially in cytology-negative patients.
We retrospectively analyzed 206 patients undergoing both SPACE and PJ-CEA testing. Patients were classified into definitive diagnosis (intraductal papillary mucinous neoplasm [IPMN], non-malignant controls, or PC) and non-definitive diagnosis groups. Because PJ-CEA may be elevated in IPMN regardless of malignant potential, the cutoff for distinguishing PC from non-malignant controls was determined by ROC analysis after excluding IPMN cases from the definitive diagnosis group. Diagnostic performance was compared for SPACE alone, PJ-CEA alone, and their combination. In the non-definitive diagnosis group, cumulative PC incidence was compared between high and low PJ-CEA subgroups using Kaplan-Meier analysis.
The optimal PJ-CEA cutoff was 7.9 ng/mL (AUC 0.924). In the definitive diagnosis group, sensitivity increased from 51.2% with SPACE alone to 86.0% when combined with PJ-CEA (p < 0.001). In the non-definitive diagnosis group, elevated PJ-CEA (≥ 7.9 ng/mL) was associated with subsequent PC (HR 11.7, p = 0.025), with a higher cumulative incidence in the high PJ-CEA subgroup (p = 0.019). These findings are based on a limited number of events and should be interpreted as exploratory, requiring external validation.
After excluding radiologically identifiable IPMN, PJ-CEA measurement during SPACE may improve diagnostic sensitivity for PC and may provide preliminary information for exploratory risk stratification in cytology-negative patients. Further external validation is required before PJ-CEA can be used to guide re-testing and surveillance strategies.

PMID:
42406281
Bibliographic data and abstract were imported from PubMed on 06 Jul 2026.

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