Clinical Interpretation of Elevated CA 19-9 Levels in Obstructive Jaundice Following Benign and Malignant Pancreatobiliary Disease.
- Author:
Min Seong KIM
1
;
Tae Joo JEON
;
Ji Young PARK
;
Jeongmin CHOI
;
Won Chang SHIN
;
Seong Eun PARK
;
Ji Young SEO
;
Young Moon KIM
Author Information
- Publication Type:Original Article
- Keywords: CA 19-9 antigen; Obstructive jaundice; Malignancy; Neoplasms; benign; Drainage
- MeSH: Bilirubin; CA-19-9 Antigen; Drainage; Follow-Up Studies; Humans; Jaundice, Obstructive*; Retrospective Studies; ROC Curve; Sensitivity and Specificity
- From:The Korean Journal of Gastroenterology 2017;70(2):96-102
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND/AIMS: Elevated carbohydrate antigen (CA) 19-9 level may be unable to differentiate between benign and malignant pancreatobiliary disease with obstructive jaundice. The study aims to determine the clinical interpretation and the diagnostic value of CA 19-9 level in pancreatobiliary diseases with coexistent obstructive jaundice. METHODS: We retrospectively reviewed the data of 981 patients who underwent biliary drainage due to obstructive jaundice following pancreatobiliary disease at Sanggye Paik Hospital for 5 years. 114 patients with serial follow-up data for CA 19-9 level were included in this study (80 patients with malignancy and 34 patients with benign diseases). We compared the levels of CA 19-9 levels and the biochemical value before and after biliary drainage. RESULTS: The rate of CA 19-9 elevation (>37 U/mL) was significantly different between the benign group and the malignant group (59% vs. 90%, p=0.001). Despite the decrease in serum bilirubin after biliary drainage, CA 19-9 levels remained elevated in 12% of patients in the benign group and in 63% of patients in the malignant group (p<0.001). Finally, 12% of patients in the benign group turned out to have malignant disease. A receiver operating characteristic analysis provided a cut-off value of 38 U/mL for differentiating benign disease from malignant disease after biliary drainage (area under curve, 0.787; 95% confidence interval, 0.703 to 0.871; sensitivity, 62%; specificity, 88%). CONCLUSIONS: This study suggested that we should consider the possibility of malignant causes if the CA 19-9 levels remain high or are more than 38 U/mL after resolution of biliary obstruction.
