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Arjun Sivarman, Ashok Muthukrishnan, Nagendra Boopathy Senguttvan, Suraj Anil Suchak, Umashankkar Kannan. Predictors of malignancy in pancreatic head mass: a prospective study. The Pan African Medical Journal. 2011;9:30 Key words: Pancreatic Carcinoma, CA 19-9 Antigen Permanent link: http://www.panafrican-med-journal.com/content/article/9/30/full Received: 31/03/2011 - Accepted: 19/07/2011 - Published: 19/07/2011 © Arjun Sivarman et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
Predictors of malignancy in pancreatic head mass: a prospective study
Arjun Sivarman1,&, Ashok Muthukrishnan1, Nagendra Boopathy Senguttvan2, Suraj Anil Suchak1, Umashankkar Kannan3
1Department of Surgery , Kasturba Medical College, Manipal, Karnataka, India, 2Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India, 3Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
&Corresponding author
Arjun Sivarman, Depatment of Surgery, Kasturba Medical College, Manipal, Karnataka, 576104, India
The objective of the study was to identify the predictive factors for malignancy in pancreatic head mass as a primary outcome and assess the value of CA 19-9 as a diagnostic tool for malignancy as a secondary outcome.
A prospective study of patients presented with pancreatic head mass was conducted in a tertiary care referral hospital, Manipal, India from May 2006 to November 2008. The study population was divided into malignant and benign groups based on the final histopathology report. A univariate and multivariate analysis of potential predictive factors for malignancy were conducted.
A total of 102 patients with pancreatic head mass were included in the study after fulfilling the inclusion/exclusion criteria. 78 were malignant and 24 were benign. There was significant weight loss (p<0.001) and high mean bilirubin levels (p=0.002) in the malignant group. Mean CA 19-9 was significantly higher in the malignant group (290.7 vs. 30.3 U/ml; p<0.001). Sensitivity and specificity of CA 19-9 for detecting malignancy in pancreatic head mass at a cut off of 35U/ml was 86% and 79% respectively. CA 19-9 positivity rate was higher with increasing cut off values of 100, 200 and 300U/ml but such high levels occurred in fewer patients. All the non-jaundiced patients (100%) with raised CA 19-9 levels were found to be malignant compared to 86% malignancy in jaundiced patients. In multivariate analysis, a combination of weight loss > 10% of body weight and bilirubin > 3 mg/dl and CA 19-9 > 35U/ml had specificity and positive predictive value of 100% for predicting malignancy in pancreatic head mass.
The presence of weight loss and jaundice and raised CA 19-9 levels together in a patient with pancreatic head mass can be predictive of malignancy. A very high CA 19-9 level can be an indicator of malignancy in a pancreatic head mass. A raised CA 19-9 level may be more predictive of malignancy in non-jaundiced patients than in jaundiced patients.
