Adjusting CA19-9 values to predict malignancy in obstructive jaundice: Influence of bilirubin and C-reactive protein

Abstract

The present study proposes CRP as a new and useful correction factor to improve the diagnostic value of the CA19-9 tumor marker in patients with cholestatic jaundice.

Association of Preoperative Platelet-to-Lymphocyte Ratio with Poor Outcome in Patients with Distal Cholangiocarcinoma

“…However, CA19-9 is increased not only in patients with pancreatic or biliary cancers but also in benign biliary diseases, such as cholestasis and obstructive jaundice, resulting in misleading false positive results [23, 24]. For this reason, there is the potential for increased serum CA19-9 levels in patients with DCC, in whom the preoperative biliary drainage is insufficient.…”

Clinical Interpretation of Elevated CA 19-9 Levels in Obstructive Jaundice Following Benign and Malignant Pancreatobiliary Disease

“…Another confounding factor is C-reactive protein, one of the markers of inflammation, which could also affect the CA 19-9 level. 10 In this regard, the present study excluded a confounding factor like inflammation due to surgical resection and infection.…”

“…Several studies have also suggested that the cut-off value was 90 U/mL, and specificity and sensitivity were 80-90% and 60-70%, respectively. 10,29 We determined the cut-off value of CA 19-9 level as 38 U/mL after biliary drainage, and this cut-off value was almost equal to the normal reference level, 37 U/mL. Sensitivity and specificity were 62% and 88%, respectively, after biliary drainage.…”

“…The cut-off value of CA 19-9 has been determined to distinguish between malignancy and benign disease by adjusting the serum bilirubin level. [6][7][8][9][10] Because of this uncertain diagnostic accuracy, use of CA 19-9 is limited to the diagnosis of tumor recurrence and prognosis of pancreatic cancer. [11][12][13] The aims of this study were to determine the clinical interpretation and the diagnostic value of an elevated CA 19-9 serum level in pancreatobiliary diseases with coexistent obstructive jaundice.…”

RE: CA 19-9 in Potentially Resectable Pancreatic Cancer: Perspective to Adjust Surgical and Preoperative Therapy

“…11,12 We and others have also suggested that this correction may slightly improve the relationship between CA 19-9 level and extent of disease in pancreatic cancer. 13ã 15 In the current issue of Annals of Surgical Oncology, Hartwig et al 16 add to the literature with one of the largest series of patients (more than 1,500) that again demonstrates that elevated CA 19-9 is associated with advanced/unresectable pancreatic adenocarcinoma despite preoperative radiologic studies demonstrating resectability.…”