title: Alternative antibody for the detection of CA19-9 antigen: a European multicenter study for the evaluation of the analytical and clinical performance of the Access GI Monitor assay on the UniCel Dxl 800 Immunoassay System.
abstract: BACKGROUND
  Gastrointestinal cancer antigen CA19-9 is known as a valuable marker for the management of patients with pancreatic cancer.
  
  
  METHODS
  The analytical and clinical performance of the Access GI Monitor assay (Beckman Coulter) was evaluated on the UniCel Dxl 800 Immunoassay System at five different European sites and compared with a reference method, defined as CA19-9 on the Elecsys System (Roche Diagnostics).
  
  
  RESULTS
  Total imprecision (%CV) of the GI Monitor ranged between 3.4% and 7.7%, and inter-laboratory reproducibility between 3.6% and 4.0%. Linearity upon dilution showed a mean recovery of 97.4% (SD + 7.2%). Endogenous interferents had no influence on GI Monitor levels (mean recoveries: hemoglobin 103%, bilirubin 106%, triglycerides 106%). There was no high-dose hook effect up to 115,000 kU/L. Clinical performance investigated in sera from 1811 individuals showed a good correlation between the Access GI Monitor and Elecsys CA19-9 (R = 0.959, slope = 1.004, intercept = +0.17). GI Monitor serum levels were low in healthy individuals (n = 267, median = 6.0 kU/L, 95th percentile=23.1 kU/L), higher in individuals with various benign diseases (n = 550, medians = 5.8-13.4 kU/L, 95th percentiles = 30.1-195.5 kU/L) and even higher in individuals suffering from various cancers (n = 995, medians = 8.4-233.8 kU/L, 95th percentiles = 53.7-13,902 kU/L). Optimal diagnostic accuracy for cancer detection against the relevant benign control group by the GI Monitor was found for pancreatic cancer [area under the curve (AUC) 0.83]. Results for the reference CA19-9 assay were comparable (AUC 0.85).
  
  
  CONCLUSIONS
  The Access GI Monitor provides very good methodological characteristics and demonstrates an excellent analytical and clinical correlation with the Elecsys CA19-9. The GI Monitor shows the best diagnostic accuracy in pancreatic cancer. Our results also suggest a clinical value of the GI Monitor in other cancers.
authors.affiliation: Institut für Klinische Chemie, Klinikum der Universität Munchen, Munich, Germany. Petra.Stieber@med.uni-muenchen.de
authors.forename: Petra
authors.initials: P
authors.lastname: Stieber
authors.forename: Rafael
authors.initials: R
authors.lastname: Molina
authors.forename: Massimo
authors.initials: M
authors.lastname: Gion
authors.forename: Axel
authors.initials: A
authors.lastname: Gressner
authors.forename: Frédéric
authors.initials: F
authors.lastname: Troalen
authors.forename: Stefan
authors.initials: S
authors.lastname: Holdenrieder
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Auge
authors.forename: Matelda
authors.initials: M
authors.lastname: Zancan
authors.forename: Matthias
authors.initials: M
authors.lastname: Wycislo
authors.forename: Véronique
authors.initials: V
authors.lastname: Jarrige
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies / Q000737:chemistry*; D019540:Area Under Curve; D018395:CA-19-9 Antigen / Q000097:blood*; D005060:Europe; D005260:Female; D006801:Humans; D007118:Immunoassay / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood / Q000175:diagnosis*; D015203:Reproducibility of Results
chemical_list: D000906:Antibodies; D018395:CA-19-9 Antigen