The Clinical Utility of CA 19-9 in Pancreatic Adenocarcinoma: Diagnostic and Prognostic Updates

Abstract

CA 19-9 and CEA are the most commonly used biomarkers for diagnosis and management of patients with pancreatic cancer. Since the original compendium by Steinberg in 1990, numerous studies have reported the use of CA 19-9 and, to a lesser extent, CEA in the diagnosis of pancreatic cancer. Here we update an evaluation of the accuracy of CA 19-9 and CEA, and, unlike previous reviews, focus on discrimination between malignant and benign disease instead of normal controls. In 57 studies involving 3,285 pancreatic carcinoma cases, the combined sensitivity of CA 19-9 was 78.2% and in 37 studies involving 1,882 cases with benign pancreatic disease the specificity of CA 19-9 was 82.8%. From the combined analysis of studies reporting CEA, the sensitivity was 44.2% (1,324 cases) and the specificity was 84.8% (656 cases). These measurements more appropriately reflect the expected biomarker accuracy in the differential diagnosis of patients with periampullary diseases. We also present a summary of the use of CA 19-9 as a prognostic tool and evaluate CA 19-9 diagnostic and prognostic utility in a 10-year, single institution experience.

Combination of tumour markers CEA and CA19-9 improves the prognostic prediction in patients with pancreatic cancer

“…Concerning diagnostic meaning, meta-analyses for CEA and CA19-9 indicate a sensitivity of 44.2% and 78.2% (specificity: 84.8% and 82.8%) 5. Although >2000 biomarker studies are present, serum CA19-9 is still the only recommended biomarker in the routine management for PC 6–8.…”

PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

“…CA19-9 has a sensitivity of 78% and specificity of 82% in discriminating between malignant and benign disease. 18 False-positive results are obtained in benign obstructive jaundice, chronic pancreatitis, cholangitis, cirrhosis and ascites. CA19-9 is most useful in assessing response to treatment in advanced cases and identifying early recurrence in resected cases.…”

“…By using positron-emitting radiotracers, PET provides unique information about the molecular and metabolic changes associated with disease. Glucose metabolism is often increased in malignant tumours resulting in increased cellular uptake of the glucose analogue 18 fluorine-2-fluoro-2-deoxy-D-glucose (FDG). Imaging the metabolic activity of tumours provides sensitive and specific information about the extent of disease.…”

“…The sensitivity and specificity of contrast-enhanced PET/CT to detect malignancy ranges from 100% to 96% and from 94% to 90%, respectively, in several studies. 52,54 The use of radiopharmaceuticals such as 18 fluorine-fluorothymidine (FLT) has been investigated in small numbers of patients. FLT-PET assesses the proportion of cells undergoing active proliferation and this process occurs before a change in glucose metabolism.…”

Development of Pancreatic Cancer: Targets for Early Detection and Treatment

“…Unfortunately, CA19-9 can also be elevated in patients with nonmalignant diseases including liver cirrhosis, chronic pancreatitis and cholangitis as well as other gastrointestinal cancers [6]. CA19-9 has been reported to discriminate between pancreatic cancer patients and healthy controls with a sensitivity and specificity of slightly over 80% [7] and between pancreatic ductal adenocarcinoma (PDAC) and benign pancreatic disease with a sensitivity of 78% and a specificity of 83% [8]. However, CA19-9 is not expressed in Lewis blood type negative patients and this limits the optimum of any test relying on CA19-9 at a sensitivity of 92% under the best of circumstances.…”