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©The Author(s) 2015.
World J Gastroenterol. Apr 14, 2015; 21(14): 4323-4333
Published online Apr 14, 2015. doi: 10.3748/wjg.v21.i14.4323
Published online Apr 14, 2015. doi: 10.3748/wjg.v21.i14.4323
Table 1 Summary of carbohydrate antigen 19-9 assay methods, results, and overall methodological quality of included studies
Ref. | Number of patient | Assay method | Cut-off for elevated CA19-9 (U/mL) | Assay results | Quality score | ||||
TP | FP | FN | TN | STARD | QUADAS | ||||
Wang et al[21], 1986 | 58 | RIA | 37 | 20 | 0 | 4 | 34 | 15 | 10 |
Safi et al[22], 1987 | 191 | RIA | 37 | 80 | 28 | 7 | 76 | 16 | 10 |
Sakamoto et al[23], 1987 | 57 | RIA | 37 | 26 | 1 | 4 | 26 | 18 | 12 |
Friess et al[24], 1993 | 154 | ELISA | 37 | 53 | 14 | 6 | 81 | 17 | 11 |
Röthlin et al[25], 1993 | 97 | RIA | 37 | 54 | 8 | 14 | 21 | 17 | 12 |
Haglund et al[26], 1994 | 199 | RIA | 37 | 148 | 3 | 31 | 17 | 16 | 11 |
Kuno et al[27], 1994 | 117 | RIA | 37 | 41 | 10 | 6 | 60 | 19 | 13 |
Pasquali et al[28], 1994 | 103 | RIA | 37 | 47 | 2 | 11 | 43 | 12 | 9 |
Satake et al[29], 1994 | 941 | RIA | 37 | 454 | 56 | 118 | 244 | 19 | 13 |
Hámori et al[30], 1997 | 94 | RIA | 37 | 48 | 4 | 14 | 28 | 11 | 7 |
Safi et al[31], 1997 | 647 | RIA | 37 | 296 | 48 | 51 | 252 | 18 | 12 |
Hayakawa et al[32], 1999 | 76 | RIA | 37 | 21 | 14 | 6 | 35 | 16 | 11 |
Kim et al[33], 1999 | 160 | ELISA | 37 | 69 | 9 | 21 | 61 | 19 | 13 |
Manes et al[34], 1999 | 58 | RIA | 37 | 30 | 3 | 4 | 21 | 17 | 11 |
Slesak et al[35], 2000 | 122 | LIA | 37 | 32 | 14 | 14 | 60 | 18 | 12 |
Maire et al[36], 2002 | 78 | ELISA | 37 | 43 | 4 | 4 | 27 | 17 | 11 |
Akashi et al[37], 2003 | 46 | RIA | 37 | 15 | 7 | 5 | 19 | 12 | 9 |
Mu et al[38], 2003 | 24 | RIA | 37 | 4 | 3 | 5 | 12 | 15 | 10 |
Cwik et al[39], 2004 | 150 | RIA | 37 | 82 | 5 | 16 | 47 | 16 | 11 |
Jiang et al[40], 2004 | 148 | ELISA | 37 | 82 | 7 | 14 | 45 | 17 | 12 |
Ventrucci et al[41], 2004 | 81 | EIA | 60 | 45 | 2 | 15 | 19 | 18 | 12 |
Teich et al[42], 2005 | 59 | ELISA | 22 | 27 | 3 | 3 | 13 | 12 | 9 |
Chang et al[43], 2007 | 111 | ELISA | 37 | 63 | 11 | 9 | 28 | 18 | 12 |
ELISA | 100 | 57 | 7 | 15 | 32 | 18 | 12 | ||
Kuhlmann et al[44], 2007 | 62 | EIA | 37 | 17 | 4 | 11 | 30 | 16 | 11 |
Liao et al[45], 2007 | 150 | ELISA | 37 | 84 | 15 | 28 | 23 | 15 | 10 |
Bedi et al[46], 2009 | 84 | ELISA | 37 | 23 | 15 | 11 | 35 | 17 | 12 |
ELISA | 100 | 14 | 7 | 20 | 43 | 17 | 12 | ||
Firpo et al[47], 2009 | 107 | ELISA | 37 | 58 | 2 | 17 | 30 | 18 | 12 |
Liao et al[48], 2009 | 102 | RIA | 37 | 47 | 22 | 11 | 22 | 16 | 10 |
Morris-Stiff et al[49], 2009 | 188 | ELISA | 37 | 70 | 31 | 3 | 84 | 19 | 13 |
Talar-Wojnarowska et al[50], 2010 | 157 | ELISA | 37 | 71 | 18 | 14 | 54 | 17 | 12 |
Zapico-Muñiz et al[51], 2010 | 102 | LIA | 100 | 35 | 7 | 12 | 48 | 16 | 11 |
Chung et al[52], 2011 | 78 | NR | 30 | 40 | 2 | 15 | 21 | 12 | 9 |
Gold et al[53], 2013 | 284 | EIA | 37 | 180 | 16 | 54 | 34 | 18 | 11 |
Kaur et al[54], 2013 | 114 | RIA | 37 | 76 | 9 | 15 | 14 | 17 | 11 |
Table 2 Additional characteristics of patients and methodology in the included studies
Ref. | Country/area | PC/CP, n | PC reference | Cross-sectional design | Consecutive or Random sampling | Blinded design | Prospective design |
Wang et al[21], 1986 | Taiwan | 24/34 | His or Cyt | No | Yes | No | Yes |
Safi et al[22], 1987 | Germany | 87/104 | His | Yes | Yes | No | Yes |
Sakamoto et al[23], 1987 | Japan | 30/27 | His | No | Yes | No | Yes |
Friess et al[24], 1993 | Germany | 59/95 | His | Yes | Yes | No | Yes |
Röthlin et al[25], 1993 | Switzerland | 68/29 | His | No | Yes | No | Yes |
Haglund et al[26], 1994 | Finland | 179/20 | His | No | Yes | No | Yes |
Kuno et al[27], 1994 | Japan | 47/70 | His | Yes | Yes | No | Yes |
Pasquali et al[28], 1994 | Italy | 58/45 | His | No | No | NR | Yes |
Satake et al[29], 1994 | Japan | 641/300 | His | Yes | Yes | No | Yes |
Hámori et al[30], 1997 | Hungary | 62/32 | His | No | Yes | No | Yes |
Safi et al[31], 1997 | Germany | 347/300 | His or Bio | Yes | Yes | No | Yes |
Hayakawa et al[32], 1999 | Japan | 27/49 | His (Bio, Aut) | No | Yes | No | Yes |
Kim et al[33], 1999 | Korea | 90/70 | His | Yes | Yes | No | Yes |
Manes et al[34], 1999 | Italy | 34/24 | His or Cyt | Yes | Yes | No | Yes |
Slesak et al[35], 2000 | Poland | 48/74 | His | No | Yes | No | Yes |
Maire et al[36], 2002 | France | 47/31 | His or Cyt | No | Yes | No | Yes |
Akashi et al[37], 2003 | Japan | 20/26 | His or Aut | No | Yes | No | Yes |
Mu et al[38], 2003 | China | 9/15 | His or Cyt | No | Yes | No | Yes |
Cwik et al[39], 2004 | Lublin | 98/52 | His | NR | Yes | NR | Yes |
Jiang et al[40], 2004 | China | 96/52 | His | Yes | Yes | No | Yes |
Ventrucci et al[41], 2004 | Italy | 60/21 | His | Yes | Yes | No | Yes |
Teich et al[42], 2005 | Germany | 30/16 | His | No | No | No | Yes |
Chang et al[43], 2007 | Taiwan | 72/39 | His | Yes | Yes | No | Yes |
New York, United States | 28/34 | His | No | Yes | NR | Yes | |
Kuhlmann et al[44], 2007 | China | 112/38 | His | No | Yes | No | Yes |
Liao et al[45], 2007 | India | 34/50 | His or Bio | Yes | Yes | No | Yes |
Bedi et al[46], 2009 | United States | 75/32 | His or Cyt | Yes | Yes | No | Yes |
Taiwan | 58/44 | His | Yes | Yes | No | Yes | |
Firpo et al[47], 2009 | United Kingdom | 73/115 | His | Yes | Yes | No | Yes |
Liao et al[48], 2009 | Poland | 85/72 | His | Yes | Yes | No | Yes |
Morris-Stiff et al[49], 2009 | Spain | 47/55 | His | Yes | Yes | No | Yes |
Talar-Wojnarowska et al[50], 2010 | Korea | 55/23 | His | Yes | Yes | No | Yes |
Zapico-Muñiz et al[51], 2010 | New York, United States | 234/50 | His or Cyt | Yes | Yes | No | Yes |
Chung et al[52], 2011 | Germany | 91/23 | His | No | Yes | No | Yes |
Table 3 Bivariate estimates of diagnostic precision based on different carbohydrate antigen 19-9 assay methods and cut-off values
Assay method or cut-off value | Number of studies | Number of participants | Sensitivity (95%CI) | Specificity (95%CI) | PLR (95%CI) | NLR (95%CI) | DOR (95%CI) |
ELISA | 11 | 1396 | 0.83 (0.80-0.86) | 0.79 (0.75-0.82) | 3.97 (2.96-5.33) | 0.20 (0.15-0.28) | 22.64 (12.44-41.22) |
RIA | 17 | 3074 | 0.82 (0.80-0.84) | 0.81 (0.79-0.83) | 4.16 (3.09-5.60) | 0.23 (0.19-0.27) | 20.14 (13.27-30.55) |
EIA | 3 | 427 | 0.75 (0.70-0.80) | 0.79 (0.70-0.86) | 3.84 (1.82-8.10) | 0.34 (0.27-0.43) | 10.29 (4.96-21.34) |
LIA | 2 | 224 | ND | ND | ND | ND | ND |
Cut-off of 37 U/mL | 30 | 4879 | 0.82 (0.80-0.83) | 0.80 (0.78-0.82) | 3.94 (3.24-4.78) | 0.24 (0.21-0.28) | 18.79 (13.67-25.82) |
Cut-off of 100 U/mL | 3 | 297 | 0.69 (0.61-0.76) | 0.85 (0.79-0.91) | 4.35 (2.86-6.61) | 0.38 (0.18-0.77) | 11.53 (4.47-29.77) |
All studies | 34 | 5115 | 0.81 (0.80-0.83) | 0.81 (0.79-0.82) | 4.08 (3.39-4.91) | 0.24 (0.21-0.28) | 19.31 (14.40-25.90) |
Table 4 Weighted meta-regression of the effects of study design, methodological quality and assay parameters on diagnostic accuracy of carbohydrate antigen 19-9
Covariate | Number of studies | Coefficient | RDOR (95%CI) | P value |
Study design and quality | ||||
STARD ≥ 13 | 30 | 0.564 | 1.76 (0.14-22.68) | 0.652 |
QUADAS ≥ 10 | 29 | -0.666 | 0.51 (0.06-4.11) | 0.514 |
Consecutive or random design | 32 | 0.924 | 2.52 (0.26-24.68) | 0.411 |
Cross-sectional design | 18 | -0.512 | 0.60 (0.28-1.28) | 0.178 |
Blinded design | 0 | ND | ND | ND |
Prospective design | 34 | ND | ND | ND |
Assay method or cut-off value | ||||
RIA | 17 | -0.619 | 0.54 (0.12-2.51) | 0.413 |
ELISA | 11 | -0.737 | 0.48 (0.10-2.26) | 0.336 |
EIA | 3 | 0.425 | 1.53 (0.29-8.14) | 0.604 |
Cut-off of 37 U/mL | 30 | 0.553 | 1.74 (0.36-8.36) | 0.474 |
Cut-off of 100 U/mL | 3 | 0.890 | 2.43 (0.72-8.26) | 0.146 |
- Citation: Su SB, Qin SY, Chen W, Luo W, Jiang HX. Carbohydrate antigen 19-9 for differential diagnosis of pancreatic carcinoma and chronic pancreatitis. World J Gastroenterol 2015; 21(14): 4323-4333
- URL: https://www.wjgnet.com/1007-9327/full/v21/i14/4323.htm
- DOI: https://dx.doi.org/10.3748/wjg.v21.i14.4323