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CA 19- 9 has been used with questionable accuracy to aid diagnosis of cholangiocarcinoma complicating primary sclerosing cholangitis. We aimed to characterize the test properties of CA 19- 9 and of a change in CA 19- 9 over time in predicting cholangiocarcinoma. Charts of 208 patients were reviewed. Fourteen patients had cholangiocarcinoma. Median CA 19- 9 was higher with cholangiocarcinoma (15 vs. 290 U/ml, p < 0.0001). A cutoff of 129 U/ml provided: sensitivity 78.6% , specificity 98.5% , adjusted positive predictive value 56.6% and negative predictive value 99.4% . The median change over time was 664 U/ml in cholangiocarcinoma compared to 6.7 U/ml in primary sclerosing cholangitis alone (p < 0.0001). A cutoff of 63.2 U/ml for change in CA 19- 9 provided: sensitivity 90% , specificity 98% and positive predictive value 42% . Only 2 patients with cholangiocarcinoma were the candidates for curative therapy. In conclusion, the positive predictive value of an elevated CA 19- 9 was 56.6% ; only advanced cases were detected by this method.
CA 19- 9 has been used with questionable accuracy to aid diagnosis of cholangiocarcinoma complicating primary sclerosing cholangitis. We aimed to characterize the test properties of CA 19-9 and of a change in CA 19-9 over time in predicting cholangiocarcinoma. Charts of 208 Patients were reviewed. Fourteen patients had cholangiocarcinoma. Median CA 19- 9 was higher with cholangiocarcinoma (15 vs. 290 U / ml, p <0.0001). A cutoff of 129 U / ml provided: sensitivity 78.6%, specificity 98.5% positive predictive value 56.6% and negative predictive value 99.4%. The median change over time was 664 U / ml in cholangiocarcinoma compared to 6.7 U / ml in primary sclerosing cholangitis alone (p <0.0001). A cutoff of 63.2 U / ml for change In conclusion, the positive predictive value of an elevated CA 19- 9 was 56.6% in CA 19- 9 provided: sensitivity 90%, specificity 98% and positive predictive value 42% ; only advanced cases were detected by this method.