| Article Details : |
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| | | Article Name : | | | Clinical significance of serum CA 19-9, CA 19-9/CRP
ratio and CA19-9/total bilirubin ratio in
differentiation between malignant and benign
obstructive jaundice | | Author Name : | | | MOATAZ M SAYED
AHMED I ELSHAFIE
MOHAMED LOTFY, SARA M ABDELHAKAM1, MARWA RUSHDY | | Publisher : | | | Bridge Center | | Article URL : |  | | | Abstract : | | | Background and AIM: Serum carbohydrate antigen (CA19-
9) is increased not only in patients with pancreatic or biliary cancers,
but also in benign biliary diseases. The aim of the present study was to
investigate the diagnostic value of CA19-9, CA19-9/CRP ratio and
CA19-9/total bilirubin ratio in differentiation between benign and
malignant obstructive jaundice in Egyptian patients.
Methods: The current prospective study included 50 patients
with obstructive jaundice who were referred for Endoscopic Retrograde
Cholangiopancreatography (ERCP). They were classified into two
groups; Group (1): 25 patients with malignant obstructive jaundice,
and Group (2) 25 patients with benign obstructive jaundice. All
included patients were subjected to: detailed history-taking, full clinical examination and laboratory investigations which included
CBC, liver and renal profiles, serum C-reactive protein (CRP) and CA
19-9.
Results: Before ERCP, CA19-9 levels were significantly higher
in malignant than in benign group, but after ERCP, CA19-9 levels
became much significantly higher in malignant than in benign group
and there was statistically significant decrease in CA19-9 level in the
benign group. Serum CA19-9 at cut-off value of 37 U/ml showed
sensitivity 80% and specificity 44% in differentiating between
malignant and benign obstructive jaundice. When CA19-9 cut-off value
was pushed up from 37 to 100 U/ml, the sensitivity decreased to 64%
while the specificity increased to 64%. By using CA19-9/total bilirubin
ratio (before ERCP) at cut-off value ? 15.84, the sensitivity decreased to
68% but specificity increased to 68%. By using the ratio of CA19-
9/CRP (before ERCP) at cut-off value ? 34.3, the sensitivity and
specificity were increased to 84% and 88%, respectively.
Conclusion: CA19-9/CRP ratio (before ERCP) at cut-off value
? 34.3 has a better sensitivity and specificity to differentiate between
the malignant and benign obstructive jaundice than CA19-9 alone and
CA19-9/total bilirubin ratio. | | Keywords : | | | Serum carbohydrate antigen (CA 19-9), C-reactive
protein, bilirubin, malignant, benign, obstructive jaundice.
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