Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun 1;10(1):8820.
doi: 10.1038/s41598-020-65720-8.

Carbohydrate antigen 19-9 elevation without evidence of malignant or pancreatobiliary diseases

Sunyoung Kim  1 , Byung Kyu Park  2 , Jeong Hun Seo  1 , Jinyoung Choi  1 , Jong Won Choi  1 , Chun Kyon Lee  1 , Jae Bock Chung  1 , Yongjung Park  3 , Dong Wook Kim  4
Affiliations

Carbohydrate antigen 19-9 elevation without evidence of malignant or pancreatobiliary diseases

Sunyoung Kim et al. Sci Rep. .

Abstract

Although carbohydrate antigen 19-9 (CA 19-9) may be elevated in benign diseases, elevated CA 19-9 may cause a fear of cancer and unnecessary follow-up studies. Research on how to approach systematically in this case is very limited. The purpose of this study was to analyze the clinical features and the causes of CA 19-9 elevation without evidence of malignant or pancreatobiliary diseases. We retrospectively reviewed the medical records of patients who had CA 19-9 elevation (≥80 U/mL) and were found to be unrelated to cancer after follow-up. After exclusion, 192 patients were included in this study. The median level of CA 19-9 was 136.5 U/mL. The causes of CA 19-9 elevation were determined in 147 (76.6%) patients, and that was unknown in 45 (23.4%). The estimated causative diseases were hepatic diseases in 63 patients, pulmonary diseases in 32, gynecologic diseases in 38, endocrine diseases in 13, and spleen disease in 1. Of 45 patients with unknown cause, 35 had normalization of CA 19-9 and 10 had persistently elevated CA 19-9. In conclusion, CA 19-9 elevation without malignancies or pancreatobiliary diseases should be systematically evaluated and followed up. We suggest an algorithm to investigate the causes and follow up these patients.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Spider blot of changes of CA 19-9 in patients with follow-up CA 19-9. (a) Patients with chronic hepatitis B; (b) Patients with bronchiectasis; (c) Patients undergoing surgery for endometriosis; (d) Patients in whom the cause of CA 19-9 elevation was unclear and CA 19-9 normalized after follow-up (●: initial CA 19-9, ○: follow-up CA 19-9).
Figure 2
Figure 2
Changes of CA 19-9 and hemoglobin A1C in subjects with uncontrolled diabetes mellitus after sugar control. (a) Initial CA 19-9 was elevated more than 80 U/ml in all subjects. After control of the blood glucose, follow-up CA 19-9 was markedly decreased in all subjects; (b) Hemoglobin A1C was decreased after control of the blood glucose in all subjects. HbA1C, hemoglobin A1C.
Figure 3
Figure 3
An algorism of systematic approach to CA 19-9 elevation without evidence of malignant or pancraetobiliary diseases. F/U, follow-up; CT, computed tomography; HbA1C, hemoglobin A1C.
See this image and copyright information in PMC

References

    1. Boeck S, Stieber P, Holdenrieder S, Wilkowski R, Heinemann V. Prognostic and therapeutic significance of carbohydrate antigen 19-9 as tumor marker in patients with pancreatic cancer. Oncology. 2006;70(4):255–264. doi: 10.1159/000094888. - DOI - PubMed
    1. Tian F, Appert HE, Myles J, Howard JM. Prognostic value of serum CA 19-9 levels in pancreatic adenocarcinoma. Ann. Surg. 1992;215(4):350–355. doi: 10.1097/00000658-199204000-00008. - DOI - PMC - PubMed
    1. Safi F, et al. High sensitivity and specificity of CA 19-9 for pancreatic carcinoma in comparison to chronic pancreatitis. Serological and immunohistochemical findings. Pancreas. 1987;2(4):398–403. doi: 10.1097/00006676-198707000-00006. - DOI - PubMed
    1. Goonetilleke KS, Siriwardena AK. Systematic review of carbohydrate antigen (CA 19-9) as a biochemical marker in the diagnosis of pancreatic cancer. Eur. J. Surg. Oncol. 2006;33(3):266–270. doi: 10.1016/j.ejso.2006.10.004. - DOI - PubMed
    1. Kim BJ, et al. How do we interpret an elevated carbohydrate antigen 19-9 level in asymptomatic subjects? Dig. Liver Dis. 2009;41(5):364–369. doi: 10.1016/j.dld.2008.12.094. - DOI - PubMed

Publication types