There is an increase in detection of occult pancreatic neoplasms with modern imaging modalities.
It is often difficult to determine the risk of malignancy before curative pancreatectomy.
Dr Mark Bloomston and colleagues reviewed patients who underwent pancreatectomy.
The team of doctors determined factors predictive of malignancy with particular attention to the serum marker carbohydrate antigen 19-9.
The doctors evaluated 118 patients undergoing radical pancreatectomy, of which 59 had malignant and 59 had benign pancreatic lesions.
|Combining older age and jaundice had a specificity of 92%|
Demographic data, preoperative carbohydrate antigen 19-9 levels, and follow-up were obtained from patient charts.
The team used logistic regression analysis to determine univariate and multivariate predictors of malignancy.
Significant multivariate predictors of malignancy were increased carbohydrate antigen 19-9, age older than 50 years, and preoperative jaundice.
The doctors noted that the sensitivity and specificity of increased preoperative carbohydrate antigen 19-9 alone were 71% and 83%, respectively.
The combination of age older than 50 years and jaundice was a more accurate predictor than carbohydrate antigen 19-9.
The team observed that the combination of older age and jaundice had a sensitivity of 76%, and specificity of 92%.
The team found that increased carbohydrate antigen 19-9 was highly specific for malignancy in older jaundiced patients.
Increased carbohydrate antigen 19-9 was also highly specific, at 97%, when the preoperative level was greater than 150 U/mL.
Dr Bloomston's team concludes, “Age and preoperative jaundice are more predictive of malignancy than carbohydrate antigen 19-9 alone unless levels are greater than 150 U/mL.”
“Preoperative carbohydrate antigen 19-9 levels should be interpreted within the context of these other clinical factors.”