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Plasma Cancer Antigen 19-9 (CA19-9) Levels Differentiate Patients With Intraductal Papillary Mucinous Neoplasm (IPMN) Carcinomas From Those With IPMN Alone
Daniel Joyce*, Gavin a. Falk, Kevin M. El-Hayek, Sricharan Chalikonda, Gareth Morris-Stiff, Matthew Walsh
Cleveland Clinic Foundation, Cleveland, OH
INTRODUCTION: Invasive adenocarcinoma is a recognized complication of IPMN in particular when the disease affects the main pancreatic duct, however, invasive carcinoma or high grade dysplasia (HGD) are often only recognized during histopathological examination of resection specimens. CA19-9 is frequently used in the diagnostic work-up of pancreatic adenocarcinoma but has not been well-investigated in IPMN, whereas carcinoembryonic antigen (CEA) is routinely evaluated. The aim of this study was to evaluate the role of CA19-9 in differentiating between IPMN carcinomas, IPMN with high-grade dysplasia (HGD) and IPMN with low/moderate (LGD&MGD) dysplasia.
METHODS: The departmental pancreatic cyst database was interrogated to identify all patients with a histopathological diagnosis of IPMN. Patients were sub-divided into three categories based on the degree of neoplastic change: IPMN carcinoma; IPMN HGD; and IPMN LGD&MGD. Ca19-9 levels were assessed in relation to the 3 categories.
RESULTS: During the period January 2000 to December 2011, 121 patients underwent pancreatic resection for IPMN. The post operative diagnoses consisted of: IPMN [n=41] carcinoma, IPMN HGD [n=18]; and IPMN LGD/MGD [n=62]. 58.3% of patients with IPMN carcinoma and 18.8% of patients with HGD had an elevated CA19-9, whereas 9.3% of those with IPMN LGD/MGD had elevated levels (see table 1). The sensitivity and specificity of CA 19-9 for IPMN carcinoma or HGD in this group was 58.3% and 88.14% respectively (see table 2). Overall, of 28 patients with a CA19-9 above the limit of normal [that being 37 IU/L], 24 (85.7%) had an associated carcinoma or HGD.
CONCLUSIONS: CA19-9 would appear to be a useful test in the assessment of IPMN and the identification of an elevated level of this tumour marker indicates a significant risk of associated carcinoma or HGD, even if there is no radiological evidence of cancer
Table 1
| Number | Median CA19-9 (IQR) | Percentage > ULN | | IPMN carcinoma | 41 | 50 (13-136) | 58.3% | | IPMN HGD | 18 | 20 (11-51) | 18.8% | | IPMN LGD/MEG | 62 | 18 (9-25) | 9.3% |
IQR = Inter-quartile range; ULN = Upper limit of normal
Table 2
| IPMN carcinoma/HGD | IPMN carcinoma | | Sensitivity | 58.3% | 46.25% | | Specificity | 88.14% | 90.7% | | Positive likelihood ratio | 4.92 | 4.96 | | Negative likelihood ratio | 0.47 | 0.59 | | Positive predictive value | 37.89 | 54.74 | | Negative predictive value | 75.00 | 85.71 |
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