Systematic review and meta-analysis of serum CA19.9 for detecting high-grade dysplasia and invasive carcinoma in IPMN patients

Current guidelines recommend routine assessment of CA19.9 at diagnosis and during folllow-up of patients with intraductal papillary mucinous neoplasm (IPMN) to detect high-grade dysplasia (HGD) and invasive carcinoma (IC). Guidelines consider an elevated serum CA19.9 level (≥ 37 U/ml) a relative indication for surgery. In a systematic review and meta-analysis including 24 studies and 5281 patients reporting CA19.9 use for resected IPMN using pathology as the reference standard, pooled estimates of diagnostic accuracy for HGD or IC demonstrated low sensitivity and high specificity. The authors conclude that in this systematic review and meta-analysis, CA19.9 at the current cutoff demonstrated poor performance in excluding HGD or IC and only modest value for ruling in IC. CA19.9 at the current cutoff should not be used as a screening test to rule out HGD and IC, nor as standalone marker.