Review
Systematic review of carbohydrate antigen (CA 19-9) as a biochemical marker in the diagnosis of pancreatic cancer

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Abstract

Background

Although many biochemical markers have been examined in pancreatic cancer none are definitive for pre-operative diagnosis. This systematic review examines studies using biochemical markers for the diagnosis of pancreatic cancer in order to appraise their role in contemporary management algorithms.

Methods

A search of the MEDLINE database was undertaken using the key words pancreatic neoplasm and serum tumour marker. Only studies providing original data on sensitivity and specificity are included and data are presented on diagnostic accuracy, effect of cholestasis and the relation of tumour stage to blood levels of markers.

Results

CA 19-9 is the most extensively evaluated with pooled data from 2283 patients. The median sensitivity of CA 19-9 for diagnosis is 79 (70–90%) and median specificity 82 (68–91%). CA 19-9 elevation in non-malignant jaundice results in a fall in specificity. Combination with other markers improves accuracy.

Conclusion

As the most extensively evaluated marker, CA 19-9 should be used in contemporary algorithms for the diagnosis of pancreatic cancer. Elevated values should be repeated after relief of jaundice.

Section snippets

Literature search and data extraction strategy

A computerised search was made of the MEDLINE database for the period from January 1990 to December 2005 inclusive. The OVID search engine (Version 9; Ovid Technologies, New York, NY, USA) was employed. The MESH headings Pancreatic neoplasm, diagnosis, CA19-9, CA 50, CEA, Dupan-2, Span-1, Serum tumour markers were used. The search was restricted to articles in English and documents relating to humans. This resulted in 348 hits. The abstracts of these reports were then retrieved and studied. At

Carbohydrate antigen (CA 19-9)

CA 19-9 is a predominantly carbohydrate antigen which was defined from the culture medium of a colorectal cancer cell line. It is a high molecular weight glycolipid derived from a monoclonal antibody isolated from mice, which is immunised with a human colon cell line. Twenty-two reports3, 12, 18, 19, 20, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44 address the role of CA 19-9 in the diagnosis of pancreatic cancer. With the sole exception of Jang's study18, all reports use

Discussion

A tumour marker that allows for the reliable diagnosis of pancreatic cancer has proved elusive. Many studies have examined markers in a large number of patients but despite this it remains difficult to draw definitive conclusions. This systematic review has examined the available reports on the use of biochemical markers for the diagnosis of pancreatic cancer. The search parameters and history are described so that the yield can be independently duplicated. As with all systematic reviews it

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