Digestive Diseases and Sciences

, Volume 50, Issue 9, pp 1734–1740 | Cite as

The Value of Serum CA 19-9 in Predicting Cholangiocarcinomas in Patients with Primary Sclerosing Cholangitis

  • Cynthia Levy
  • James Lymp
  • Paul Angulo
  • Gregory J. Gores
  • Nicholas Larusso
  • Keith D. Lindor


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.


primary sclerosing cholangitis cholangiocarcinoma biliary tract malignancy carbohydrate 19-9 


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Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Cynthia Levy
    • 1
  • James Lymp
    • 2
  • Paul Angulo
    • 3
  • Gregory J. Gores
    • 1
  • Nicholas Larusso
    • 3
  • Keith D. Lindor
    • 1
    • 4
  1. 1.Division of Gastroenterology, Hepatology and NutritionUniversity of FloridaGainesville
  2. 2.Biostatistics at Mayo Clinic RochesterMinnesota
  3. 3.Gastroenterology and Hepatology at Mayo ClinicRochester
  4. 4.Division of Gastroenterology and HepatologyMayo Clinic RochesterRochester

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