Serum carcinoembryonic antigen and carbohydrate antigen 19-9 for prediction of malignancy and invasiveness in intraductal papillary mucinous neoplasms of the pancreas: A meta-analysis

Abstract

The clinical importance of intraductal papillary mucinous neoplasms (IPMN) of the pancreas has been increasing due to the large number of newly diagnosed cases. A meta-analysis was used to assess the accuracy of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) for the identification of malignant and invasive IPMN. A literature search of PubMed and Web of Knowledge was conducted. Studies included in the analysis addressed the diagnostic accuracy of serum CEA and CA19-9 and pooled estimates of sensitivity, specificity, positive- and negative-likelihood ratios (PLR and NLR), diagnostic odds ratio (DOR) and receiver operating characteristic curves were calculated using random-effects models. Predefined subgroup analysis was performed. Fifteen studies (published between 2001 and 2013) were analyzed, including a total of 1,629 patients. Pooled estimates of CEA in malignant and invasive IPNM prediction were: Pooled sensitivity, 18 and 18%; pooled specificity, 93 and 95%; PLR, 2.83 and 3.54; NLR, 0.89 and 0.89; and DOR, 3.35 and 3.6, respectively. Pooled estimates of CA19-9 in malignant and invasive IPMN prediction were: Pooled sensitivity, 40 and 52%; pooled specificity, 89 and 88%; PLR, 2.93 and 3.78; NLR, 0.74 and 0.6; and DOR, 4.34 and 6.33, respectively. In conclusion, serum CEA has low sensitivity and high specificity for malignant and invasive IPMN. Serum CA19-9 is a useful non-invasive preoperative tool for differentiating between invasive and benign IPMN and should be taken into account in the decision to perform surgery.

Keywords: carbohydrate antigen 19-9; carcinoembryonic antigen; diagnostic odds ratio; intraductal papillary mucinous neoplasms; negative-likelihood ratio; positive-likelihood ratio; sensitivity; specificity.

Figure 1

Flow chart demonstrating the algorithm for identifying suitable studies for inclusion.

Figure 2

Forest plots of serum carcinoembryonic antigen for predicting malignant intraductal papillary mucinous neoplasms. (A) Sensitivity; (B) specificity; (C) positive-likelihood ratio (LR); and (D) negative-LR. CI, confidence interval.

Figure 3

sROC curve of serum carcinoembryonic antigen for predicting malignant intraductal papillary mucinous neoplasms. sROC, summary receiver operating characteristic; AUC, area under the sROC curve; SE, standard error.

Figure 4

Forest plots of serum carcinoembryonic antigen for predicting malignant intraductal papillary mucinous neoplasms. (A) Sensitivity; (B) specificity; (C) positive-likelihood ratio (LR); and (D) negative-LR. CI, confidence interval.

Figure 5

sROC curve of serum carcinoembryonic antigen for predicting malignant intraductal papillary mucinous neoplasms. sROC, summary receiver operating characteristic; AUC, area under the sROC curve; SE, standard error.

Figure 6

Forest plots of serum carbohydrate antigen 19-9 for predicting malignant intraductal papillary mucinous neoplasms. (A) Sensitivity; (B) specificity; (C) positive-likelihood ratio (LR); and (D) negative-LR. CI, confidence interval.

Figure 7

sROC curve of serum carbohydrate antigen 19-9 for predicting malignant intraductal papillary mucinous neoplasms. sROC, summary receiver operating characteristic; AUC, area under the sROC curve; SE, standard error.

Figure 8

Forest plots of serum carbohydrate antigen 19-9 for predicting malignant intraductal papillary mucinous neoplasms. (A) Sensitivity; (B) specificity; (C) positive-likelihood ratio (LR); and (D) negative LR. CI, confidence interval.

Figure 9

sROC curve of serum carbohydrate antigen 19-9 for predicting malignant intraductal papillary mucinous neoplasms. sROC, summary receiver operating characteristic; AUC, area under the sROC curve; SE, standard error.