Serum Level of Ca 19-9 Increases Ability of IgG4 Test to Distinguish Patients with Autoimmune Pancreatitis from Those with Pancreatic Carcinoma

Background Autoimmune pancreatitis (AIP) is often difficult to distinguish from pancreatic carcinoma or other pancreatobiliary diseases. High serum levels of carbohydrate antigen 19-9 (Ca 19-9) are indicative of malignancies, whereas high levels of immunoglobulin (Ig)G4 (>1.4 g/l) are characteris...

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Bibliographic Details
Published in:Digestive diseases and sciences 2014-06, Vol.59 (6), p.1322-1329
Main Authors: van Heerde, Marianne J., Buijs, J., Hansen, B. E., de Waart, M., van Eijck, C. H. J., Kazemier, G., Pek, C. J., Poley, J. W., Bruno, M. J., Kuipers, E. J., van Buuren, H. R.
Format: Article
Language:English
Subjects:
Adult
Aged
Analysis
Autoimmune Diseases - blood
Autoimmune Diseases - diagnosis
Autoimmune Diseases - immunology
Bilirubin
Bilirubin - blood
Biochemistry
CA-19-9 Antigen - blood
CA-19-9 Antigen - metabolism
Cancer
Carcinoma
Carcinoma - diagnosis
Carcinoma - metabolism
Carcinoma - pathology
Female
Gastroenterology
Gene Expression Regulation, Neoplastic - physiology
Hepatology
Humans
Immunoglobulin G
Immunoglobulin G - blood
Male
Medicine
Medicine & Public Health
Middle Aged
Oncology
Original Article
Pancreatic cancer
Pancreatic Neoplasms - diagnosis
Pancreatic Neoplasms - metabolism
Pancreatic Neoplasms - pathology
Pancreatitis
Pancreatitis - blood
Pancreatitis - diagnosis
Pancreatitis - immunology
Proteins
Serologic Tests
Transplant Surgery
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Summary:Background Autoimmune pancreatitis (AIP) is often difficult to distinguish from pancreatic carcinoma or other pancreatobiliary diseases. High serum levels of carbohydrate antigen 19-9 (Ca 19-9) are indicative of malignancies, whereas high levels of immunoglobulin (Ig)G4 (>1.4 g/l) are characteristic of AIP. We investigated whether serum levels of these proteins can differentiate between these diseases. Methods We measured levels of Ca 19-9 and IgG4 in serum samples from 33 patients with AIP, 53 with pancreatic carcinoma, and 145 with other pancreatobiliary disorders. We determined cut-off levels for each assay. Logistic regression analysis was used to evaluate combined data on Ca 19-9, IgG4, and bilirubin levels. Results Low levels of Ca 19-9 were independently associated with AIP, compared with pancreatic adenocarcinoma [odds ratio (OR) 0.28; 95 % confidence interval (CI) 0.13–0.59; p  = 0.0001]. Using an upper level of 74 U/ml, the assay for Ca 19-9 identified patients with AIP with 73 % sensitivity and 74 % specificity. Using a lower level of 2.6 g/l, the assay for IgG4 identified these patients with 70 % sensitivity and 100 % specificity. Combining data, levels of Ca 19-9  1.0 g/l identified patients with AIP with 94 % sensitivity and 100 % specificity. Conclusions Patients with AIP have lower levels of Ca 19-9 than those patients with pancreatic carcinoma. Measurement of either the Ca 19-9 or the IgG4 level alone are not accurate enough for diagnosis. However, the combination of Ca 19-9  1.0 g/l distinguishes patients with AIP from those patients with pancreatic carcinoma with 94 % sensitivity and 100 % specificity.
ISSN:0163-2116
1573-2568
DOI:10.1007/s10620-013-3004-3