The clinical utility and limitations of serum carbohydrate antigen (CA19-9) as a diagnostic tool for pancreatic cancer and cholangiocarcinoma

Sundeep Singh, Shou Jiang Tang, Jayaprakash Sreenarasimhaiah, Luis F. Lara, Ali Siddiqui

Research output: Contribution to journalArticlepeer-review

84 Scopus citations


Background: CA19-9 is a tumor marker for pancreatic cancer, cholangiocarcinoma, and other malignancies. However, its sensitivity and specificity is suboptimal in clinical practice, which we hypothesized limits its clinical utility. Aims: To evaluate the clinical utility and limitations of CA19-9 as a tumor marker. Methods: We performed a retrospective review of CA19-9 levels (U/ml) in 483 consecutive patients between 2006 and 2008 at two university hospitals. We abstracted clinical, radiographic, and pathological data and final diagnoses. Descriptive and non-parametric analyses were performed. Results: Patients presenting with jaundice had the highest CA19-9 (420) compared to other complaints (<20) (p < 0.01). The indications with the highest CA19-9 had evidence of biliary obstruction (71), liver mass (54), and pancreatic head mass (27) compared to other indications (<15) (p < 0.01). The diagnoses with the highest CA19-9 (p < 0.01) were cholangiocarcinoma (476), pancreatic cancer (161), and choledocholithiasis (138). Using a receiver operator curve to evaluate CA19-9, the area under the curve was 0.7 when evaluating all patients for pancreatic cancer or cholangiocarcinoma or patients with pancreatic head mass for pancreatic cancer. Conclusions: This study found that for pancreatic cancer and cholangiocarcinoma, CA19-9 had poor clinical utility as a tumor marker and did not change patient management. Elevations in CA19-9 were associated with biliary obstruction based on clinical history, laboratory data, and diagnoses.

Original languageEnglish (US)
Pages (from-to)2491-2496
Number of pages6
JournalDigestive Diseases and Sciences
Issue number8
StatePublished - Aug 1 2011


  • CA19-9
  • Cholangiocarcinoma
  • Pancreatic cancer
  • Serum carbohydrate antigen

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology


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