The value of serum CA 19-9 in predicting cholangiocarcinomas in patients with primary sclerosing cholangitis

CA 19-9 has been used with questionable accuracy to aid diagnosis of cholangiocarcinoma complicating primary sclerosing cholangitis. We aimed to characterize the test properties of CA 19-9 and of a change in CA 19-9 over time in predicting cholangiocarcinoma. Charts of 208 patients were reviewed. Fo...

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Bibliographic Details
Published in:Digestive diseases and sciences 2005-09, Vol.50 (9), p.1734-1740
Main Authors: LEVY, Cynthia, LYMP, James, ANGULO, Paul, GORES, Gregory J, LARUSSO, Nicholas, LINDOR, Keith D
Format: Article
Language:English
Subjects:
Bile Duct Neoplasms - blood
Bile Duct Neoplasms - etiology
Biological and medical sciences
CA-19-9 Antigen - blood
Cholangiocarcinoma - blood
Cholangiocarcinoma - etiology
Cholangitis, Sclerosing - complications
Female
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Middle Aged
Other diseases. Semiology
Predictive Value of Tests
Reference Values
Tumors
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Summary:CA 19-9 has been used with questionable accuracy to aid diagnosis of cholangiocarcinoma complicating primary sclerosing cholangitis. We aimed to characterize the test properties of CA 19-9 and of a change in CA 19-9 over time in predicting cholangiocarcinoma. Charts of 208 patients were reviewed. Fourteen patients had cholangiocarcinoma. Median CA 19-9 was higher with cholangiocarcinoma (15 vs. 290 U/ml, p < 0.0001). A cutoff of 129 U/ml provided: sensitivity 78.6%, specificity 98.5%, adjusted positive predictive value 56.6% and negative predictive value 99.4%. The median change over time was 664 U/ml in cholangiocarcinoma compared to 6.7 U/ml in primary sclerosing cholangitis alone (p < 0.0001). A cutoff of 63.2 U/ml for change in CA 19-9 provided: sensitivity 90%, specificity 98% and positive predictive value 42%. Only 2 patients with cholangiocarcinoma were the candidates for curative therapy. In conclusion, the positive predictive value of an elevated CA 19-9 was 56.6%; only advanced cases were detected by this method.
ISSN:0163-2116
1573-2568
DOI:10.1007/s10620-005-2927-8