VALUE OF SERUM CA 19-9 IN OBSTRUCTIVE JAUNDICE

Abstract

The aim of this work was to evaluate whether CA19-9 levels could in fact accurately differentiate between benign and malignant obstructive jaundice or not. This study was performed on 60 patients presented to the endoscopy unit of Theodor Bilharz Research Institute who were complaining of obstructive jaundice and submitted to ERCP. The patients were divided into two groups. Group I: included 30 patients with calcular obstructive jaundice. They were 20 males and 10 females. Group II: included 30 patients with malignant obstructive jaundice. They were 28 males and 2 females. Both groups were subjected to full history, clinical examination, biochemical tests, abdominal ultrasonography, ERCP and the level of CA19.9 was measured before and after intervention. The results of our study revealed that males were more prone to malignancy than females. There was a significant difference between the two groups regarding the total, direct bilirubin and GGT levels as they were higher in the malignant group. By ultrasound, there was a significant difference in the CBD diameter as it was more dilated in the malignant group and also IHBRD were more frequent in the malignant group. After ERCP, there was a high statistically significant decrease in CA19.9 level after biliary drainage in calcular cases more than the decrease in malignant cases. When comparing the baseline CA19.9 level between both groups, CA19.9 was statistically higher in malignant group than the calcular one. At a cutoff 40.5 IU/ml, ROC curve confirmed the high sensitivity (80%) and specificity (90%) of serum CA19.9 in detecting the malignant cases of obstructive jaundice. Sensitivity decrease with the increase of CA 19.9 cut off while specificity increases. There was no effect of the number of stones on the baseline level of CA19.9 in calcular cases. And similarly, no relation was found between the level of the stricture and baseline level of CA19.9 among patients in the malignant group.