Resumen

ORTIZ HIGAREDA, Vanessa et al. Sensitivity and specificity of CA-19-9 for the diagnosis of pancreatobiliary neoplasms in patients with obstructive-origin jaundice. Cir. gen [online]. 2011, vol.33, n.1, pp.14-20. ISSN 1405-0099.

Objective: To describe the biological behavior of the tumor marker CA 19-9 in cholestasis to determine its usefulness for the diagnosis of pancreatobiliary cancer in patients with obstructive-origin jaundice. Sede: General Hospital of Mexico, third level health care center. Mexico City. Design: Prospective, longitudinal, and comparative study. Statistical analysis: T and Kolmogorov Smirnov tests for independent samples; diagnostic value test (sensitivity, specificity, and global value). Analysis with ROC curves was performed to identify sensitivity and specificity at the different cutting points. Patients and methods: We included 54 patients with a diagnosis of obstructive-origin jaundice. They were divided in two groups according to the final diagnosis, malignant disease vs. benign disease. Serum CA 19-9 was determined at admittance and once cholestasis had been resolved, and the levels were correlated with the final diagnosis. Results: In jaundice patients, with a cut point of 60 U/mL to distinguish between malignant and benign disease, the CA 19-9 marker has a sensitivity of 80% and a specificity of 90%. Once cholestasis had been resolved with a cut point of 39 U/mL, sensitivity was of 71% with a 96% specificity. Normalization of the marker after bile drainage is highly suggestive of benign pathology. The persistence of high levels (higher than 60 U/mL) is highly suggestive of malignancy with a sensitivity of 58% and specificity of 100%. Conclusions: Cholestasis does modify the sensitivity and specificity of the CA 19-9 marker for the diagnosis of pancreatobiliary malignant neoplasms; therefore, in the presence of obstructive-origin jaundice, the 60 U/mL cut point offers a sensitivity of 80% with a specificity of 90% to be able to distinguish between malignant and benign disease. Once cholestasis has been resolved, persistence of high levels is highly suggestive of malignancy.

Palabras llave : CA 19-9; pancreatobiliary neoplasms; duodenal-biliary-pancreatic neoplasms; cholestasis; jaundice; cancer of the pancreas; cholangiocarcinoma; adenocarcinoma of the pancreas; adenocarcinoma of the ampulla of Vater.