Diagnostic utility of clinical and biochemical parameters in pancreatic head malignancy patients with normal carbohydrate antigen 19-9 levels

Abstract

Background: Carbohydrate antigen (CA)19-9 that is the most widely used biomarker for pancreatic cancer has certain limitations in diagnosis, which results in a tough job to distinguish pancreatic cancer from benign tumors with normal CA19-9. The aim of this study was to investigate the diagnostic utility of clinical parameters and serum markers in patients with pancreatic head masses but without elevated CA19-9. Methods: Retrospectively, 106 (69 malignant, 37 benign) of 487 patients admitted for pancreatic head masses were enrolled with CA19-9 level of <37u/ml. Clinical parameters and serum biomarkers were assessed. Among the patients with pancreatic head mass, male individuals (p=0.025) and elder individuals (p<0.001) were more likely to have cancer; and cancer patients were more likely to present with abdominal-pain (p=0.023), weight-loss (p=0.013) and jaundice (p<0.001). Serum bilirubin levels among malignancies, including total bilirubin (p<0.001), direct bilirubin (p<0.001) and indirect bilirubin (p<0.001), were considerably higher than those of benign ones. Logistic regression further concluded that age-distribution, abdominal-pain and direct-bilirubin were three independent factors correlating with final diagnosis. However, CEA (p=0.156) was not sufficient enough to exclude pancreatic cancer. Conclusions: In patients with pancreatic head masses and CA19-9 of <37u/ml, age-distribution, abdominal-pain and direct bilirubin might be helpful in differential diagnosis. CEA was insufficient for exclusion of malignancy.

Management Modalities of Pancreatic Cancer and Surgical Outcomes of Braun's Anastomosis Addition in Whipple's Procedure: A Single-center Prospective Study

“…In this study, serum CA19-9 value (0-37 u/ml) was detected in (77.8%) of patients, and AFP value (0-40 ng/mL) noticed in (73%) of patients. Our findings agreed with the literature reported increased CA19-9 and AFP values in patients with advanced PC and considered CA19-9 as gold standard biomarker used in postoperative monitoring of PC patients (10,33). Moreover, serum CEA value (0-2.5 ng/mL) was found in (54%) of patients.…”

Sensitive electrochemical immunoassay with signal enhancement based on nanogold-encapsulated poly(amidoamine) dendrimer-stimulated hydrogen evolution reaction

“…2 In people with pancreatic masses, CA 19-9 can be useful in distinguishing between cancer and other diseases of the gland. 3,4 Hence, sensitive and specific determination of low-abundant CA 19-9 in biological fluids would be advantageous in clinical diagnosis.…”

Evaluation of Malignancy Risk of Ampullary Tumors Detected by Endoscopy Using 2-[18F]FDG PET/CT

“…Applying a 37 U/mL cut-off, patients with higher CA19-9 levels had a 4.1-fold higher risk of malignancy ( P < 0.001). However, this significance was diminished in multivariable and subgroup analyses, indicating a diminished role of traditional biochemical markers in differentiating early small cancers from adenomas [ 41 ]. Interestingly, a borderline association was observed between non-overweight status and cancer, particularly among EP candidates.…”