CA 19-9 to Rule Out Pancreatic or Biliary Cancer Among Patients with Cholestasis: An Unsuitable Test?

The Highest Ever Reported Level of Carbohydrate Antigen 19-9: A Case Report

“…It is generally believed that benign conditions cause only moderate elevations, while very high levels are mainly related to malignancies, consistent with the results of previous papers [8,9]. However, some researchers have published cases that documented extremely elevated CA 19-9 serum concentrations (up to 187,000 U/ml) secondary to benign biliary obstruction that have rapidly normalized after recovery of biliary patency [10].…”

“…However; since we found no case report with CA 19-9 levels higher than 100.000 U/ml in pancreatic malignancy, while a CA 19-9 level of 187,000 U/ml reported in simple choledocholithiasis [10], we can postulate that the presence of both of these conditions may have had a cumulative effect in producing the extremely high level of CA 19-9 in this patient.…”

Elevation of Carbohydrate Antigen 19.9 in Benign Hepatobiliary Conditions and Its Correlation with Serum Bilirubin Concentration

“…Benign conditions of the HPB tract such as Mirizzi syndrome, autoimmune pancreatitis, benign biliary strictures secondary to primary sclerosing cholangitis, and pancreatic exocrine dysfunction in diabetic patients, have also been associated with abnormal elevation of CA19.9 [7][8][9][10]. Hyperbilirubinemia secondary to biliary obstruction is the common feature in the majority of these conditions and the CA19.9 tends to normalize following the restoration of biliary drainage [9,11]. There is increasing evidence to suggest that hyperbilirubinemia reduces the specificity of CA19.9 in the detection of HPB malignancy albeit maintaining a high sensitivity [3,12].…”

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

“…Several studies have suggested an adjustment of cholestasis for the CA 19-9 level for the interpretation of a high CA 19-9 level in pancreatobiliary cancer. 28,29 In the above studies, the appropriate normal range of CA 19-9 was determined to be less than 34 U/mL by using the ROC curve analysis. Patients whose CA 19-9 levels were within the normal range were included in the analysis as normal levels in the pancreatobiliary disease may be meaningful at levels lower than the reference level.…”

“…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.…”