CA19-9 serum levels in obstructive jaundice: clinical value in benign and malignant conditions

Marrelli, Daniele; Caruso, Stefano; Pedrazzani, Corrado; Neri, Alessandro; Fernandes, Eduardo; Marini, Mario; Pinto, Enrico; Roviello, Franco

doi:10.1016/j.amjsurg.2008.12.031

« Previous Next »The American Journal of Surgery
Volume 198, Issue 3 , Pages 333-339, September 2009

CA19-9 serum levels in obstructive jaundice: clinical value in benign and malignant conditions

Daniele Marrelli, M.D.
- Department of Human Pathology and Oncology, Unit of Surgical Oncology, University of Siena, Viale Bracci-Policlinico “Le Scotte” 53100, Siena, Italy
- Corresponding author. Tel.: +0039 0577 585882; fax: +0039 0577 585882
Stefano Caruso, M.D.
- Department of Human Pathology and Oncology, Unit of Surgical Oncology, University of Siena, Viale Bracci-Policlinico “Le Scotte” 53100, Siena, Italy
Corrado Pedrazzani, M.D.
- Department of Human Pathology and Oncology, Unit of Surgical Oncology, University of Siena, Viale Bracci-Policlinico “Le Scotte” 53100, Siena, Italy
Alessandro Neri, M.D.
- Department of Human Pathology and Oncology, Unit of Surgical Oncology, University of Siena, Viale Bracci-Policlinico “Le Scotte” 53100, Siena, Italy
Eduardo Fernandes, M.D., M.R.C.S.
- Renal Department, Transplant Unit, Hammersmith Hospital, Imperial College Healthcare Trust, London, UK
Mario Marini, M.D.
- Unit of Gastroenterology, Digestive Endoscopy, University of Siena, Siena, Italy
Enrico Pinto, M.D.
- Department of Human Pathology and Oncology, Unit of Surgical Oncology, University of Siena, Viale Bracci-Policlinico “Le Scotte” 53100, Siena, Italy
Franco Roviello, M.D.
- Department of Human Pathology and Oncology, Unit of Surgical Oncology, University of Siena, Viale Bracci-Policlinico “Le Scotte” 53100, Siena, Italy

Received 3 October 2008; received in revised form 28 November 2008 published online 20 April 2009.

Abstract

Background

Obstructive jaundice is frequently associated with false CA19-9 elevation in benign conditions. The diagnostic accuracy of this tumor marker was evaluated in the present longitudinal study.

Methods

In 128 patients admitted for obstructive jaundice (87 with pancreato-biliary malignancy and 41 benign disease) serum CA19-9 was measured. Statistical analysis of marker levels obtained before and after endoscopic biliary drainage was performed in 60 patients.

Results

Elevated CA19-9 levels (>37 U/mL) were found in 61% of benign cases and 86% of malignancies. After biliary drainage, decrease of serum CA19-9 was observed in 19 of 38 malignant cases and in almost all benign cases (Wilcoxon matched pairs test: P = .207 and P <.001, respectively). Receiver operating characteristic (ROC) analysis identified a cut-off value of 90 U/mL to be associated with improved diagnostic accuracy after biliary drainage (sensitivity 61%, specificity 95%).

Conclusions

In the presence of successfully drained obstructive jaundice, CA19-9 serum levels that remain unchanged or measure more than 90 U/mL are strongly indicative of a malignant cause of obstruction. However, the real clinical utility of this marker remains controversial.

Keywords: Tumor marker, CA19-9, Obstructive jaundice, Pancreato-biliary malignancy, Endoscopic retrograde cholangiopancreatography