title: Serum CA19-9 measurement increases the effectiveness of staging laparoscopy in patients with suspected pancreatic malignancy.
abstract: OBJECTIVE
  Staging laparoscopy for suspected pancreatic neoplasia is not widely accepted due to its low yield. The aim of this study was to determine if serum carbohydrate antigen (CA19-9) levels could be used to improve the selection of patients for staging laparoscopy.
  
  
  METHODS
  The data from a prospectively collected database (1997-2004) with 159 patients who had computed tomography-predicted resectable disease and who had undergone laparoscopic staging were analysed to determine if a low preoperative CA19-9 level (< or =150 kU/l, or < or =300 kU/l with a bilirubin >35 micromol/l) identified patients in whom laparoscopy was not useful.
  
  
  RESULTS
  The CA19-9 level was >150 kU/l in 96 patients of whom 75 (78%) were considered resectable following laparoscopic assessment. There were 63 patients with a CA19-9 < or =150 kU/l of whom 60 (95%) were considered resectable following laparoscopic assessment. The sensitivity, specificity, positive predictive value and negative predictive value for CA19-9 < or =150 kU/l in predicting that laparoscopic assessment would judge patients as resectable were 44, 88, 95 and 22%, respectively. A cut-off level of < or =300 kU/l in patients with a bilirubin >35 micromol/l produced values of 30, 94, 94 and 28%, respectively. By using CA19-9 < or =150 kU/l, laparoscopy could have been avoided in 40% of patients, increased to 55% of patients with adjustment for the presence of jaundice; concomitantly, the yield from laparoscopy would have been increased from 15 to 22 and 25%, respectively.
  
  
  CONCLUSIONS
  Use of serum CA19-9 levels would increase the efficiency of laparoscopic staging in patients with suspected pancreatic malignancy.
authors.affiliation: Department of Surgery, University of Liverpool, Liverpool, UK.
authors.forename: S
authors.initials: S
authors.lastname: Connor
authors.forename: L
authors.initials: L
authors.lastname: Bosonnet
authors.forename: N
authors.initials: N
authors.lastname: Alexakis
authors.forename: M
authors.initials: M
authors.lastname: Raraty
authors.forename: P
authors.initials: P
authors.lastname: Ghaneh
authors.forename: R
authors.initials: R
authors.lastname: Sutton
authors.forename: J P
authors.initials: JP
authors.lastname: Neoptolemos
mesh_terms: D001650:Bile Duct Neoplasms / Q000175:diagnosis; D001653:Bile Ducts, Intrahepatic; D001663:Bilirubin / Q000097:blood; D018395:CA-19-9 Antigen / Q000097:blood*; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis*; D018281:Cholangiocarcinoma / Q000175:diagnosis; D006801:Humans; D010535:Laparoscopy; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D018579:Patient Selection; D011859:Radiography; D012680:Sensitivity and Specificity
chemical_list: D018395:CA-19-9 Antigen; D001663:Bilirubin