title: Preoperative carbohydrate antigen 19-9 is most predictive of malignancy in older jaundiced patients undergoing pancreatic resection.
abstract: OBJECTIVE
  Given the increased detection of occult pancreatic neoplasms with modern imaging modalities, it is often difficult to determine the risk of malignancy before curative pancreatectomy. We reviewed patients who underwent pancreatectomy to determine factors predictive of malignancy with particular attention to the serum marker carbohydrate antigen 19-9 (CA19-9).
  
  
  METHODS
  One hundred eighteen patients underwent radical pancreatectomy for malignant (n = 59) or benign (n = 59) pancreatic lesions. Demographic data, preoperative CA19-9 levels (normal, <37 U/mL), and follow-up were obtained from patient charts. Logistic regression analysis was used to determine univariate and multivariate predictors of malignancy.
  
  
  RESULTS
  Significant multivariate predictors of malignancy were increased CA19-9, age older than 50 years, and preoperative jaundice. The sensitivity and specificity of increased preoperative CA19-9 alone were 71% and 83%, respectively. The combination of age older than 50 years and jaundice was a more accurate predictor than CA19-9 (sensitivity, 76%; specificity, 92%). Increased CA19-9 was highly specific (97%) for malignancy in older jaundiced patients or when the preoperative level was greater than 150 U/mL.
  
  
  CONCLUSIONS
  Age and preoperative jaundice are more predictive of malignancy than CA19-9 alone unless levels are greater than 150 U/mL. Preoperative CA19-9 levels should be interpreted within the context of these other clinical factors.
authors.affiliation: Department of Surgery, Ohio State University, Columbus, OH 43210, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Bloomston
authors.forename: Tanios S
authors.initials: TS
authors.lastname: Bekaii-Saab
authors.forename: Kavitha
authors.initials: K
authors.lastname: Kosuri
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Cowgill
authors.forename: W Scott
authors.initials: WS
authors.lastname: Melvin
authors.forename: E Christopher
authors.initials: EC
authors.lastname: Ellison
authors.forename: Peter
authors.initials: P
authors.lastname: Muscarella
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D018395:CA-19-9 Antigen / Q000097:blood*; D005260:Female; D006801:Humans; D007565:Jaundice / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010182:Pancreatic Diseases / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen