Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2015; 21(14): 4323-4333
Published online Apr 14, 2015. doi: 10.3748/wjg.v21.i14.4323
Carbohydrate antigen 19-9 for differential diagnosis of pancreatic carcinoma and chronic pancreatitis
Si-Biao Su, Shan-Yu Qin, Wen Chen, Wei Luo, Hai-Xing Jiang
Si-Biao Su, Shan-Yu Qin, Wei Luo, Hai-Xing Jiang, Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Wen Chen, Department of Educational Administration, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Author contributions: Jiang HX designed the study, searched the databases, extracted the data, analyzed the results, and wrote the manuscript; Su SB helped design the study, search the databases, and write and revise the manuscript; Qin SY formulated the research question, and helped with database searches and analysis; Chen W and Luo W helped design the data abstraction form and served as second reviewers in extracting the data; all authors have read and approved the final manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Hai-Xing Jiang, Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, No. 22 Shuangyong Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. Jianghaixing2001@163.com
Telephone: +86-771-5312726 Fax: +86-771-5356758
Received: September 20, 2014
Peer-review started: September 21, 2014
First decision: October 14, 2014
Revised: October 30, 2014
Accepted: January 8, 2015
Article in press: January 8, 2015
Published online: April 14, 2015
Processing time: 207 Days and 10.9 Hours
Abstract

AIM: To evaluate the utility of carbohydrate antigen 19-9 (CA19-9) for differential diagnosis of pancreatic carcinoma and chronic pancreatitis.

METHODS: We searched the literature for studies reporting the sensitivity, specificity, and other accuracy measures of serum CA19-9 levels for differentiating pancreatic carcinoma and chronic pancreatitis. Pooled analysis was performed using random-effects models, and receiver operating characteristic (ROC) curves were generated. Study quality was assessed using Standards for Reporting Diagnostic Accuracy and Quality Assessment for Studies of Diagnostic Accuracy tools.

RESULTS: A total of 34 studies involving 3125 patients with pancreatic carcinoma and 2061 patients with chronic pancreatitis were included. Pooled analysis of the ability of CA19-9 level to differentiate pancreatic carcinoma and chronic pancreatitis showed the following effect estimates: sensitivity, 0.81 (95%CI: 0.80-0.83); specificity, 0.81 (95%CI: 0.79-0.82); positive likelihood ratio, 4.08 (95%CI: 3.39-4.91); negative likelihood ratio, 0.24 (95%CI: 0.21-0.28); and diagnostic odds ratio, 19.31 (95%CI: 14.40-25.90). The area under the ROC curve was 0.88. No significant publication bias was detected.

CONCLUSION: Elevated CA19-9 by itself is insufficient for differentiating pancreatic carcinoma and chronic pancreatitis, however, it increases suspicion of pancreatic carcinoma and may complement other clinical findings to improve diagnostic accuracy.

Keywords: Pancreatic carcinoma; Chronic pancreatitis; Carbohydrate antigen; Diagnosis; Meta-analysis

Core tip: Pancreatic carcinoma and chronic pancreatitis show similar clinical manifestations. Differential diagnosis of pancreatic carcinoma and chronic pancreatitis remains a challenge, particularly in patients with pancreatic masses that may be benign (inflammatory) or malignant. Carbohydrate antigen 19-9 (CA19-9) shows promise for differentiating the diseases. We evaluated the usefulness of CA19-9 in this systematic review.