P1426 - Elevated Serum Carbohydrate Antigen 19-9 Correlates With Presence of High-Grade Dysplasia or Focal Adenocarcinoma in Branch Duct Intrapapillary Mucinous Neoplasms: A Systematic Review and Meta-Analysis

Reza V. Milano, MD, MPH¹, Camilo J. Acosta, MD¹, Shyam Vedantam, DO², Jamie S. Barkin, MD, MACG¹, Sunil Amin, MD, MPH¹, Shria Kumar, MD, MSc(Epi)³, Sean Bhalla, MD¹, Jodie A. Barkin, MD, FACG^1
1University of Miami, Leonard M. Miller School of Medicine, Miami, FL; ²University of Miami/Jackson Memorial Hospital, Miami, FL; ³University of Miami, Miami, FL

Introduction: Branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) are among the most common pancreatic cystic lesions, however, optimal surveillance strategies to identify progression to high-grade dysplasia (HGD) or malignancy in this group of IPMNs remain particularly unclear. Most guidelines for IPMN surveillance focus on radiologic features. There is a paucity of data on serum carbohydrate antigen 19-9 (CA 19-9) levels dedicated specifically to BD-IPMNs. The aim of this systematic review and meta-analysis was to determine whether elevated serum CA 19-9 is correlated to presence of either HGD or malignancy within BD-IPMNs.

Methods: Medline, Embase, CINAHL, Scopus, and Web of Science were systematically queried from inception through April 2023 to identify studies that evaluated serum CA 19-9 levels in histologically confirmed pancreatic BD-IPMNs in adults, with all associated permutations. Eighty-three studies underwent full text review by two authors with a third author to settle disputes. Studies included were English language original studies describing a serum CA 19-9 level for both BD-IPMNs with low grade dysplasia (“benign”), and BD-IPMNs with HGD or carcinoma (combined outcome defined as “malignant”). Mantel-Haenszel pooled odds ratios (OR) and 95% confidence intervals (CI) for these were constructed using a random effects model. Statistical heterogeneity was assessed using the I2 statistic and publication bias was assessed using funnel plots.

Results: Four retrospective cohort studies were included for a total of 2,453 patients. There was a statistically significant difference in the level of serum CA 19-9 between benign and malignant BD-IPMNs, with higher levels found in the malignant group. Serum CA 19-9 level was approximately 52 units/mL higher in malignant vs. benign BD-IPMNs (SMD = 52.14; 95% CI [7.02, 97.26]; p < 0.00001).

Discussion: A significantly higher level of serum CA 19-9 was found in malignant compared to benign BD-IPMNs. Specific serum CA 19-9 cutoff levels for malignancy were unable to be calculated, however our study suggests that any elevation in serum CA 19-9 in a patient with BD-IPMN may be associated with increased risk of HGD/malignancy in BD-IPMNs. Further studies are needed to evaluate the optimal cutoff for elevation of serum CA 19-9 in detecting malignant BD-IPMNs. Serum CA 19-9 may be a useful additive tool in non-invasive surveillance of BD-IPMNs for progression to HGD or malignancy.



Disclosures:


Reza V. Milano, MD, MPH¹, Camilo J. Acosta, MD¹, Shyam Vedantam, DO², Jamie S. Barkin, MD, MACG¹, Sunil Amin, MD, MPH¹, Shria Kumar, MD, MSc(Epi)³, Sean Bhalla, MD¹, Jodie A. Barkin, MD, FACG¹. P1426 - Elevated Serum Carbohydrate Antigen 19-9 Correlates With Presence of High-Grade Dysplasia or Focal Adenocarcinoma in Branch Duct Intrapapillary Mucinous Neoplasms: A Systematic Review and Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.