title: Utility of serum CA19-9 levels in the diagnosis of pancreatic ductal adenocarcinoma in an endoscopic ultrasound referral population.
abstract: OBJECTIVE
  Recent data suggest the use of carbohydrate antigen (CA) 19-9 as a potential marker in the early detection of pancreatic ductal adenocarcinoma (PDAC) when used in the appropriate clinical setting. Here, we assess the utility of CA19-9 in PDAC detection in a select population of pancreatic endoscopic ultrasound (EUS) referrals.
  
  
  METHODS
  Retrospective review of an institutional EUS Pancreas Registry containing cases referred from November 2002 to November 2011 was completed for categorical analyses with CA19-9 level. A separate case-control study for the subset of non-elevated CA19-9 PDAC population was also performed to characterize the clinical features in this unique group of patients.
  
  
  RESULTS
  Two hundred eighty-three patients had available CA19-9 data in the registry and were included in the study. Compared to the typical PDAC distribution, the proportion of patients with stage I disease was significantly higher in our registry population (P < 0.0001). Elevated CA19-9 levels most often reflected a diagnosis of PDAC relative to other pancreaticobiliary diagnoses. However, we observed that 15 % of patients with PDAC had normal CA19-9 levels. Clinical characteristics for this false-negative PDAC group compared to the true-positive group demonstrated a predilection for detection of cancer in the body/tail of the pancreas (P = 0.03), increased likelihood of lymph node metastases (P = 0.03), and initial presentation with vague abdominal pain or pancreatic mass as an incidental finding on imaging studies (P = 0.01).
  
  
  CONCLUSIONS
  Elevated CA19-9 demonstrated a greater likelihood of PDAC diagnosis relative to benign pancreatic pathology, and higher levels of CA19-9 were in line with worse PDAC stage. Patients with normal CA19-9 PDAC may represent a unique subclass of patients, presenting with atypical clinical features, and possibly more advanced stage disease at the time of diagnosis. These patients may benefit from more diligent EUS examination or perhaps closer follow-up management.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California, Davis Medical Center, 4150 V St. PSSB 3500, Sacramento, CA, 95817-1460, USA.
authors.forename: Dhavan A
authors.initials: DA
authors.lastname: Parikh
authors.forename: Blythe
authors.initials: B
authors.lastname: Durbin-Johnson
authors.forename: Shiro
authors.initials: S
authors.lastname: Urayama
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood*; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood / Q000175:diagnosis*; D016022:Case-Control Studies; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000097:blood / Q000175:diagnosis*; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen