BACKGROUND: Obstructive jaundice is frequently associated with false CA19-9 elevation in benign conditions. The diagnostic accuracy of this tumor marker was evaluated in the present longitudinal study.METHODS: In 128 patients admitted for obstructive jaundice (87 with pancreato-biliary malignancy and 41 benign disease) serum CA19-9 was measured. Statistical analysis of marker levels obtained before and after endoscopic biliary drainage was performed in 60 patients.RESULTS: Elevated CA19-9 levels (>37 U/mL) were found in 61% of benign cases and 86% of malignancies. After biliary drainage, decrease of serum CA19-9 was observed in 19 of 38 malignant cases and in almost all benign cases (Wilcoxon matched pairs test: P = .207 and P < .001, respectively). Receiver operating characteristic (ROC) analysis identified a cut-off value of 90 U/mL to be associated with improved diagnostic accuracy after biliary drainage (sensitivity 61%, specificity 95%).CONCLUSIONS: In the presence of successfully drained obstructive jaundice, CA19-9 serum levels that remain unchanged or measure more than 90 U/mL are strongly indicative of a malignant cause of obstruction. However, the real clinical utility of this marker remains controversial. (C) 2009 Elsevier Inc. All rights reserved.

CA19-9 serum levels in obstructive jaundice: clinical value in benign and malignant conditions

Pedrazzani, Corrado;Marini, Mario;
2009-01-01

Abstract

BACKGROUND: Obstructive jaundice is frequently associated with false CA19-9 elevation in benign conditions. The diagnostic accuracy of this tumor marker was evaluated in the present longitudinal study.METHODS: In 128 patients admitted for obstructive jaundice (87 with pancreato-biliary malignancy and 41 benign disease) serum CA19-9 was measured. Statistical analysis of marker levels obtained before and after endoscopic biliary drainage was performed in 60 patients.RESULTS: Elevated CA19-9 levels (>37 U/mL) were found in 61% of benign cases and 86% of malignancies. After biliary drainage, decrease of serum CA19-9 was observed in 19 of 38 malignant cases and in almost all benign cases (Wilcoxon matched pairs test: P = .207 and P < .001, respectively). Receiver operating characteristic (ROC) analysis identified a cut-off value of 90 U/mL to be associated with improved diagnostic accuracy after biliary drainage (sensitivity 61%, specificity 95%).CONCLUSIONS: In the presence of successfully drained obstructive jaundice, CA19-9 serum levels that remain unchanged or measure more than 90 U/mL are strongly indicative of a malignant cause of obstruction. However, the real clinical utility of this marker remains controversial. (C) 2009 Elsevier Inc. All rights reserved.
Tumor marker
CA19-9
Obstructive jaundice
Pancreato-biliary malignancy
Endoscopic retrograde cholangiopancreatography
Adult
Aged
Aged, 80 and over
Biliary Tract Neoplasms
Biomarkers, Tumor
CA-19-9 Antigen
Cholangiopancreatography, Endoscopic Retrograde
Diagnosis, Differential
Drainage
Female
Humans
Jaundice, Obstructive
Male
Middle Aged
Pancreatic Neoplasms
Predictive Value of Tests
ROC Curve
Sensitivity and Specificity
Statistics, Nonparametric
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/1029752
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