Combined Clinical Value of CA19-9, C-reactive Protein and Bilirubin in Differentiation between Malignant and Benign Obstructive Jaundice

Abstract

The aim of work in this study is to find possible relationship between CA19-9,C-reactive protein and bilirubin and there role in differentiation between the benign and malignant obstructive jaundice. The study was conducted on 50 patients admitted for obstructive jaundice to department of Gastroenterology and Hepatology in Ain Shams university hospital and Ahmed Maher Teaching Hospital between January 2014 and January 2016. Patients were classified into two groups: Group (1) malignant jaundice: 25patients,13male and 12 female, their age range (35-70Y.) etiology of obstructive Jaundice were variable (cancer pancreas 48%, cholangiocarcinoma12%, periambularycarcinoma 16%,cancer gall bladder 4%,malignant CBD stricture20%). Group (2) benign jaundice:25 patients,14 male and 11 female, their age range (24-81Y.) etiology of obstructive Jaundice were variable (C.B.D stones 64%,biliary pancreatitis12%, chronic papillitis 4%, benign C.B.D stricture 20%). 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. Computed Tomography (abdominal C.T).done for patient suspect to have malignant obstructive jaundice and all histopathological or cytological examinations of any specimens were recorded to confirm malignant diagnoses for inclusion into the malignant group. The result of our study revealed that younger ages are more prone to benign jaundice with significant difference in the two groups. There was a significant difference in the Hb,ALT,Albuminbetween the two groups as they were higher in the benign one.Also the Alk.Pmuch higher in malignant group with a highly significant difference. The total serum bilirubin level at time of patients admission was much higher in malignant group with a highly significant difference. Before and after release of obstruction the serum bilirubin levels higher in malignant group with a high significant difference and when we compared between serum bilirubin level before and after release of obstruction in each group there was a statistically high significant decrease in bilirubin level. The CRP levels were higher in benign than malignant group with significant difference. Before release of obstruction CA19-9 levels higher in malignant group than benign with a statistically significant difference but after release of obstruction CA19-9 levels became much higher in malignant group than benign with a statistically high significant difference and there was significant decrease in CA19-9 level in benign group. The sensitivity and specificity ofCA19-9 at cut off value >37 (U/ml) were 80% and 44% respectivelywhile pushing up cut off value to>100 (U/ml) the sensitivity decreased while the specificity increased to become 64% and 64% respectively. The Sensitivity for CA19-9 after dividing it by to total serum bilirubin before ERCP at Cut off value<=15.84 decreased to 68% but specificity increased to 68%.