The utility of CA 19-9 in the diagnoses of cholangiocarcinoma in patients without primary sclerosing cholangitis

Patel, Anand H; Harnois, Denise M.; Klee, George G.; LaRusso, Nicholas F.; Gores, Gregory J.

doi:10.1111/j.1572-0241.2000.01685.x

Cited by 372 publications

(202 citation statements)

References 15 publications

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“…However, the diagnostic potential for the detection of CCA is fairly poor. Serum CA19–9 levels show a wide variation in sensitivity 38–90% and specificity 50–98% [9, 11-14]. A recently published meta-analysis including a total of 1,264 patients with CCA showed a pooled sensitivity of only 72% with a specificity of 84% for the differentiation between CCA and healthy controls as well as patients with benign biliary disease (e.g.…”

Section: Resultsmentioning

confidence: 99%

“…Carbohydrate antigen (CA) 19–9 and carcinoembryonic antigen (CEA) are the most extensively studied biomarkers for CCA, but their diagnostic and prognostic capabilities are limited and rather unspecific [9, 10]. Due to the lack of large and well-characterized CCA study populations, the evaluation of novel biomarkers has remained challenging.…”

Section: Introductionmentioning

confidence: 99%

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Circulating Biomarkers for Cholangiocarcinoma

Loosen

Vucur

Roderburg

et al. 2018

Dig Dis

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Background: Cholangiocarcinoma (CCA) represents the second most common primary liver malignancy. The incidence rate has constantly increased over the last decades and CCA patients face a dismal prognosis with a 5-year survival rate of less than 5% for advanced stage of disease. Surgical tumor resection has remained the only potentially curative treatment option in daily practice but is often not feasible due to advanced disease stage at initial diagnosis. Summary: The early detection of cholangiocarcinoma is essential to provide patients with a potentially curative treatment. Furthermore, prognostic biomarkers represent a valuable tool to offer patients a tailored therapeutic approach in accordance to their life expectancy. The clinically most established biomarker carbohydrate antigen 19–9 shows only a limited diagnostic and prognostic power, encouraging the evaluation of novel biomarkers for cholangiocarcinoma in the last years. Key Massage: In this review, we assess currently available and potential future biomarkers for the diagnosis and prognosis of cholangicarcinoma.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Circulating Biomarkers for Cholangiocarcinoma

Loosen

Vucur

Roderburg

et al. 2018

Dig Dis

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“…The compared sensitivity and specificity of CA19-9 in the same study population of 4 studies were 0.70 and 0.71, respectively, and the AUC for CA19-9 was 0.73. In other independent studies, CA19-9 exhibited varied diagnostic performance with a sensitivity of 40-90%, specificity 50-98% [17,[19][20][21][22][23], and positive predictive value (PPV) of 16-40% depending on cut-off values [20,22,23]. Regarding the other traditional serum markers, the estimated sensitivity and specificity of carcinoembryonic antigen (CEA) were 20%-68% and 82-100%, respectively [15,46], while for cancer antigen 125 (CA125) sensitivity and specificity were 31.25%, and 96% [47], respectively.…”

Section: Discussionmentioning

confidence: 99%

“…The National Comprehensive Cancer Network (NCCN) guidelines only take carbohydrate antigen 19-9 (CA19-9) as a baseline of continuous surveillance and do not recommend other tumor markers as diagnostic indicators [18]. CA19-9 has a wide variation in sensitivity (50-90%) and specificity (54-98%) [17,[19][20][21][22][23], is falsely elevated in benign biliary diseases, is relieved in biliary obstruction and sepsis, and undetectable in Lewis antigen negative population [17]. Thus, the early diagnosis of BTC remains challenging [24,25].…”

Section: Introductionmentioning

confidence: 99%

The Diagnostic Value of Pyruvate Kinase Isoenzyme Type M2 for Biliary Tract Carcinoma. A Systematic Review and Meta-Analysis

Wang

Liu

Zhang

et al. 2018

JGLD

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Background & Aims: Growing evidence has shown that M2-PK is involved in cancer diagnosis and prognosis. The overall diagnostic accuracy of the pyruvate kinase isoenzyme type M2 (M2-PK) in biliary tract carcinoma (BTC) remains controversial. We performed a meta-analysis to evaluate the diagnostic value of M2-PK for BTC.Methods: The online PubMed, Cochrane, Web of Science, and Embase databases were searched for eligible studies published until August 8th, 2017. The Quality Assessment for Diagnostic Accuracy Studies 2 (QUADAS-2) was used to evaluate study quality. All statistical analyses were conducted with Stata 12.0.Results: We included 7 studies from 5 articles with 410 patients with BTC and 438 controls. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and AUC for M2-PK in the diagnosis of BTC were 0.79 (95%CI 0.70-0.86), 0.81 (95%CI 0.71-0.88), 4.1 (95%CI 2.5-6.8), 0.26 (95%CI 0.16-0.41), 17.159 (95%CI 5.468-54.071), and 0.87 (95%CI 0.83-0.89), respectively. The same indicators assessed for CA19-9 were as follows: 0.70 (95%CI 0.62-0.77), 0.71 (95%CI 0.45-0.87), 2.38 (95%CI 1.2-4.73), 0.43 (95%CI 0.34-0.53), 6.28 (95%CI 2.4-16.44) and 0.73 (95%CI 0.69-0.77), respectively. Additionally, the diagnostic value of M2-PK varied based on characteristics of golden methods and different cut-off values.Conclusions: This meta-analysis showed that M2-PK had a better diagnostic accuracy for BTC compared with CA19-9, with moderate diagnostic performance. However, prospective studies are required to confirm its diagnostic value.

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“…In patients with PSC, a CA 19-9 greater than 100 U/ml has been shown in a more recent case-controlled study to have a sensitivity and specificity of 75 and 80%, respectively [77]. In the absence of PSC, a CA 19-9 greater than 100 U/ml may have limited utility in the diagnosis of cholangiocarcinoma, with a sensitivity of 53%, and true negative rates of 76 and 92% when compared to patients with benign liver disease and bile duct strictures, respectively [78]. Biliary CA-125 may be useful as an adjunct test [79], although further investigation of this is warranted.…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

A Review and Update on Cholangiocarcinoma

2004

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Cholangiocarcinoma is a malignant neoplasm arising from the biliary epithelium that was first described by Durand-Fardel in 1840. Today, it continues to defy diagnosis and treatment. It is difficult to diagnose in part because of its relative rarity, and because it is clinically silent until it becomes advanced disease with obstructive symptoms. The worldwide incidence of cholangiocarcinoma has risen over the past three decades. There is marked geographic variability in the prevalence of this disease, due in large part to regional environmental risk factors. Surgical resection remains the only curative treatment, and high priorities are improving diagnostic methods, and clinical staging for resection once the disease is suspected. A recent trend towards aggressive surgical management has improved outcomes. Chemotherapy, palliative stenting, and radiation are reserved for patients who are not resectable, those with recurrence after surgery, and those who decline surgical intervention. Recent trials using combination systemic chemotherapy and neoadjuvant chemoradiation are promising, but require further study. Over the past five years, several important studies have yielded new insights into the molecular mechanisms of cholangiocarcinoma tumorigenesis. In this review we discuss epidemiology, etiologic factors, molecular pathogenesis, diagnosis, staging, and treatment of cholangiocarcinoma. Particular focus is on recent studies into the cellular and molecular pathogenesis of the disease, recent chemotherapy trials, and newer methods of staging and screening for this devastating malignancy.

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The utility of CA 19-9 in the diagnoses of cholangiocarcinoma in patients without primary sclerosing cholangitis

Abstract: These data suggest that the serum CA 19-9 determination is a useful addition to the available tests for the differential diagnosis of cholangiocarcinoma.

Cited by 372 publications

References 15 publications

Circulating Biomarkers for Cholangiocarcinoma

Circulating Biomarkers for Cholangiocarcinoma

The Diagnostic Value of Pyruvate Kinase Isoenzyme Type M2 for Biliary Tract Carcinoma. A Systematic Review and Meta-Analysis

A Review and Update on Cholangiocarcinoma

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