Evaluation of serum carbohydrate antigen 19-9 as a diagnostic marker for pancreatic malignancy

Authors

  • A.K.M. Ahsan Ullah Department of Surgery, Aichi Medical College and Hospital, Dhaka, Bangladesh
  • S. M. Ferdous Ahmed Department of Surgery, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh
  • A. S. M. Lokman Hossain Chowdhury Department of Pediatric Surgery, Mymensingh Medical College, Mymensingh, Bangladesh
  • Saad Mohammed Department of Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
  • M. Mozammel Haque Shahid Ahsan Ullah Master General Hospital, Gazipur, Bangladesh
  • Abunur M. Masud Rana Department of Surgery, Jahurul Islam Medical College and Hospital, Bajitpur, Kishoreganj, Bangladesh

DOI:

https://doi.org/10.18203/2349-2902.isj20203762

Keywords:

Carbohydrate antigen 19-9, Tumor marker, Pancreatic cancer

Abstract

Background: Carbohydrate antigen (CA) 19-9 is considered as a tumor marker in biliary-pancreatic malignancy. Though a high level may indicate the presence of a malignant disorder, it may rise even in benign condition. Similarly, the value may be normal even in malignant condition.

Methods: An observational comparative study was conducted in the Department of Surgery of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from 01 June 2016 to 31 May 2017 to find out the sensitivity and specificity of CA 19-9 as a tumor marker in pancreatic malignancy in our perspective and to find out a cut-off value of CA 19-9 which might prove as a definitive indication of pancreatic malignancy.

Results: The study shows when the cut off value of CA 19-9 is 37 U/ml. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) were 77.8%, for all four characteristics respectively. But if the serum CA 19-9 threshold used to diagnose pancreatic cancer was raised to 100 and 120, sensitivity decreased to 72.2% and 66.7% and NPV decreased to 76.2% and 73.9% respectively. However, specificity increased to 88.9% and 94.4% and PPV increased to 86.7% and 92.3% respectively.

Conclusions: Serum CA 19-9 level may be considered as an important determinant in the diagnosis of malignant pancreatic diseases and to assess the resectability of the lesions preoperatively, but other adjuncts are necessary in the overall management of pancreatic diseases.

References

Williams NS, Bulstrode CJK, O’Connel PR. Bailey and Love’s short practice of surgery. 26th ed. Broken Sound, Parkway, NW: CRC Press, Taylor & Francis Group. 2013.

Ellison LF, Wilkins K. An update on cancer survival. Health Rep. 2010;21:55-60.

Maisonneuve P, Lowenfels AB. Epidemiology of pancreatic cancer: an update. Digestive Dis. 2010;28:645-56.

Li J, Merl MY, Chabot J, Saif MW. Updates of adjuvant therapy in pancreatic cancer: where are we and where are we going? Highlights from the "2010 ASCO Annual Meeting". J Pancreas. 2010;11(4):310-2.

Harsha HC, Kandasamy K, Ranganathan P. A compendium of potential biomarkers of pancreatic cancer. Public Library of Science Med. 2009:6(4):46.

Koprowski H, Steplewski Z, Mitchell K, Herlyn M. Colorectal carcinoma antigens detected by hybridoma antibodies. Somatic Cell Mol Genetics. 1979;5(6):57-71.

Umashankar K, Ballehaninna R, Chamberlain S. The clinical utility of serum CA 19-9 in the diagnosis, prognosis and management of pancreatic adenocarcinoma: an evidence based appraisal. J Gastrointest Oncol. 2012;3:105-19.

Pavai S, Yap SF. The clinical significance of elevated levels of serum CA 19-9. Med J Malaysia. 2003;58(5):667-72.

Stienberg W. The clinical utility of the serum CA 19-9 tumour-associated antigen. Am J Gastroenterol. 1990;85:350-5.

Bhattarai A, Bharat J, Santosh T. Serum CA 19-9 Levels in benign and malignant diseases associated with the gastrointestinal tract. Annals Clin Chem Lab Med. 2015;1(2):35-41.

Bedi MMS, Gandhi MD, Jacob G, Lekha V, Venugopal H, Ramesh A. CA 19-9 to differentiate benign and malignant masses inchronic pancreatitis: is there any benefit?. Ind J Gastroenterol. 2009;28:24-7.

Sawabu N, Takemori Y, Toya D, Yoneshima M, Kidani H, Satomura Y, Ohta H, Hattori H. Factors affecting serum levels of CA 19-9 with special reference to benign hepatobiliary and pancreatic diseases. Gastroenterol Jap. 1986;21(5):491-8.

Arakawa Y, Kobayashi H, Ozaki T, Ariga H. Serum determination of CA 19-9 in patients with digestive cancer and its diagnostic evaluation. Jap J Cancer Chemo. 1984;11(4):917-25.

Satake KM, Kanazawa GM, Kho IM, Chung YSM, Umeyama KM. A clinical evaluation of carbohydrate antigen 19-9 and carcinoembryonic antigen in patients with pancreatic carcinoma. J Surg Oncol. 1985;29(1):15-21.

Savarino V, Mansi C, Pugliese V, Ferrara GB, Arcuri V, Celle G. Evaluation of a new tumor-antigen in pancreatic cancer. Digestion. 1994;29(1):1-4.

Jalanko H, Kuusela P, Roberts P, Sipponen P, Haglund CA, Makela O. Comparison of a new tumour marker, CA 19-9, with alphafetoprotein and carcinoembryonic antigen in patients with upper gastrointestinal diseases. J Clin Pathol. 1984;37(2):218-22.

Ritts RE, Pitt HA. CA 19-9 in pancreatic cancer. Surg Oncol Clin North Am. 1998;7(1):93-101.

Ozkan H, Kaya M, Cengiz A. Comparison of tumor marker CA 242 with CA 19-9 and carcinoembryonic antigen (CEA) in pancreatic cancer. Hepatogastroenterol. 2003;50(53):69- 74.

Kau SY, Shyr YM, Su CH, Wu CW, Lui WY. Diagnostic and prognostic values of CA 19-9 and CEA in periampullary cancers. J Am Coll Surg. 1999;188(4):415-20.

Paganuzzi M, Onetto M, Marroni P. 1988. CA 19-9 and CA 50 in benign and malignant pancreatic and biliary diseases. Cancer. 1988;61:2100-8.

Jason AZ, Jessica MR, Ziogas A, Steven M, Lipkin HAC. Race, socioeconomic status, treatment, and survival time among pancreatic cancer cases in California, cancer epidemiology biomarkers & prevention. Am Soc Prev Oncol. 2007;16(3):546-52.

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Published

2020-08-27

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Original Research Articles