Clinical implication of serum carcinoembryonic antigen and carbohydrate antigen 19-9 for the prediction of malignancy in intraductal papillary mucinous neoplasm of pancreas

Kim, Jae Ri; Jang, Jin–Young; Kang, Mee Joo; Park, Taesung; Lee, Seung Yeoun; Jung, Woohyun; Chang, Jihoon; Shin, Young June; Han, Youngmin; Kim, Sun‐Whe

doi:10.1002/jhbp.275

Cited by 68 publications

(51 citation statements)

References 23 publications

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“…International Consensus Guidelines published in 2012 suggested several features indicative of malignant transformation, including the dilatation or calibre change in MPD, large cysts, mural nodules and septal wall thickening. In 2017, the guidelines added raised serum carbohydrate antigen (CA) 19‐9 level as a worrisome feature, based on studies that showed a relationship between high CA 19‐9 levels and malignant IPMN. The guidelines recommended careful surveillance or resection of IPMN with these features.…”

Section: Introductionmentioning

confidence: 99%

Validation of a nomogram to predict the risk of cancer in patients with intraductal papillary mucinous neoplasm and main duct dilatation of 10 mm or less

Jung

Park

Kim

et al. 2019

British Journal of Surgery

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Background Intraductal papillary mucinous neoplasm (IPMN) is premalignant pancreatic lesion. International guidelines offer limited predictors of individual risk. A nomogram to predict individual IPMN malignancy risk was released, with good diagnostic performance based on a large cohort of Asian patients with IPMN. The present study validated a nomogram to predict malignancy risk and invasiveness of IPMN using both Eastern and Western cohorts. Methods Clinicopathological and radiological data from patients who underwent pancreatic resection for IPMN at four centres each in Eastern and Western countries were collected. After excluding patients with missing data for at least one malignancy predictor in the nomogram (main pancreatic duct diameter, cyst size, presence of mural nodule, serum carcinoembryonic antigen and carbohydrate antigen (CA) 19‐9 levels, and age). Results In total, data from 393 patients who fit the criteria were analysed, of whom 265 were from Eastern and 128 from Western institutions. Although mean age, sex, log value of serum CA19‐9 level, tumour location, main duct diameter, cyst size and presence of mural nodule differed between the Korean/Japanese, Eastern and Western cohorts, rates of malignancy and invasive cancer did not differ significantly. Areas under the receiver operating characteristic (ROC) curve values for the nomogram predicting malignancy were 0·745 for Eastern, 0·856 for Western and 0·776 for combined cohorts; respective values for the nomogram predicting invasiveness were 0·736, 0·891 and 0·788. Conclusions External validation of the nomogram showed good performance in predicting cancer in both Eastern and Western patients with IPMN lesions.

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Section: Introductionmentioning

confidence: 99%

Validation of a nomogram to predict the risk of cancer in patients with intraductal papillary mucinous neoplasm and main duct dilatation of 10 mm or less

Jung

Park

Kim

et al. 2019

British Journal of Surgery

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“…Of these studies, 33 investigated mural nodules5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 21 examined dilatation of the main pancreatic duct (MPD)7 9, 15 16, 18 21, 23 26, 27 30, 32 36, 38, 39, 40, 41, 42, 43, 44, 45, 46, 21 analysed cyst size5 7, 8, 9 14, 15 18, 20 23, 25 27, 28 31, 36 38, 40 41, 43 47, 48, 49, 17 assessed CA19‐9 increase14 …”

Section: Resultsmentioning

confidence: 99%

Predictive performance of factors associated with malignancy in intraductal papillary mucinous neoplasia of the pancreas

et al. 2018

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BackgroundEstimation of the risk of malignancy in intraductal papillary mucinous neoplasia (IPMN) of the pancreas is a clinical challenge. Several routinely used clinical factors form the basis of the current consensus guidelines. This study aimed to determine the predictive values of the most commonly assessed risk factors.MethodsA meta‐analysis of individual risk factors of malignancy in IPMN was performed. Contingency tables were derived from these data, and sensitivity, specificity, negative and positive predictive values, and diagnostic odds ratios (DOR) were determined. Hierarchical summary receiver operating characteristic (HSROC) curves for each factor were calculated and the respective area under the curve (AUC) was assessed.ResultsA total of 3443 studies were screened initially. Analysis of recent literature revealed 60 studies with 13 relevant risk factors including clinical, serological and radiological parameters. The largest area under the HSROC curve was found for weight loss (0·84) and jaundice/raised bilirubin level (0·80), followed by increased carcinoembryonic antigen (CEA) (0·79) or carbohydrate antigen (CA) 19‐9 (0·78) levels. The most sensitive factors were patient age (71 per cent) and mural nodules (65 per cent), and jaundice/raised bilirubin level (97 per cent) and increased CEA level (95 per cent) were most specific. None of the analysed factors reached a positive or negative level of prediction beyond 90 per cent.ConclusionNone of the established criteria safely distinguishes malignant from non‐malignant lesions.

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“…Data from our institution [35] indicate that serum CA 19-9 in patients with resected BD-IPMN is useful for detecting invasive carcinoma (AUC 0.68; 95% CI 0.52-0.84) but not for detecting HGD without invasive carcinoma (AUC 0.54; 95% CI 0.42-0.67). Importantly, a cutoff of 100 units/ml had the highest accuracy for detecting invasive carcinoma (93%), compared with the more commonly used cutoff of 37 units/ ml (83%) [36,37]. Elevated serum CA 19-9 has now been included as a worrisome feature in the revised IAP 2012 Fukuoka consensus guidelines [10]; while our experience would support this addition, we must keep in mind that its utility appears to be restricted to detecting invasive carcinoma (and not HGD), and the optimal cutoff value may still need to be determined.…”

Section: Circulating Biomarkers For Prediction Of High-risk Intraductmentioning

confidence: 99%

Intraductal Papillary Mucinous Neoplasms of the Pancreas: Strategic Considerations

et al. 2017

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Intraductal papillary mucinous neoplasms (IPMN) are cystic neoplasms with the potential for progression to pancreatic cancer. Recognized by the global medical community just over two decades ago, IPMN have gained great epidemiological and clinical relevance thanks to the widespread use of cross-sectional abdominal imaging, which has led to a surge in the number of incidental pancreatic cysts being diagnosed. As our understanding of this disease has improved, we now know that some IPMN have a very elevated risk of cancer and require surgical resection, while others are low-risk lesions and can be followed. The approach to IPMN must therefore strike a balance between preventing the over-utilization of surgery and the timely recognition and treatment of patients with high-risk lesions. Several clinical, radiographic, and laboratory parameters have been proposed to risk-stratify IPMN, leading to the publication of management guidelines that do not always converge in their recommendations. The goal of this clinical therapeutic review is to describe the strategic approach to IPMN at the Massachusetts General Hospital, and how our current understanding, management algorithm, and future directions have been informed by research efforts at our institution and other centers.

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Clinical implication of serum carcinoembryonic antigen and carbohydrate antigen 19-9 for the prediction of malignancy in intraductal papillary mucinous neoplasm of pancreas

Abstract: Serum CA19-9 is significantly higher in patients with malignant IPMN, especially in patients with invasive and main duct type IPMN. The diagnostic power of serum CA19-9 in predicting malignancy is comparable to that of MPD >5 mm and mural nodules.

Cited by 68 publications

References 23 publications

Validation of a nomogram to predict the risk of cancer in patients with intraductal papillary mucinous neoplasm and main duct dilatation of 10 mm or less

Validation of a nomogram to predict the risk of cancer in patients with intraductal papillary mucinous neoplasm and main duct dilatation of 10 mm or less

Predictive performance of factors associated with malignancy in intraductal papillary mucinous neoplasia of the pancreas

Intraductal Papillary Mucinous Neoplasms of the Pancreas: Strategic Considerations

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