{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:18:15Z","timestamp":1791245895610,"version":"4.1.0"},"reference-count":50,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Current guidelines recommend routine assessment of serum carbohydrate antigen 19.9 (CA19.9) at diagnosis and during follow-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 (\u226537 U\/mL) a worrisome feature and a relative indication for surgery.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the diagnostic accuracy of CA19.9 for identifying patients with IPMN at high risk of HGD and IC.<\/jats:p>\n <\/jats:sec>\n \n Data Sources<\/jats:title>\n PubMed, Embase (Ovid), and Web of Science databases (inception to March 1, 2025).<\/jats:p>\n <\/jats:sec>\n \n Study Selection<\/jats:title>\n Studies reporting on diagnostic accuracy of CA19.9 (cut-off 37 U\/mL) in patients with resected IPMN.<\/jats:p>\n <\/jats:sec>\n \n Data Extraction and Synthesis<\/jats:title>\n Data extraction was completed by 3 reviewers (March to December 2025). Risk of bias was assessed using the QUADAS-2 tool and evidence certainty with Grading of Recommendations Assessment, Development and Evaluation. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy Studies reporting guidelines and the Cochrane Diagnostic Test Accuracy protocol were applied for overall conduct. A random-effects meta-analysis was conducted in December 2025 to obtain a pooled estimate of diagnostic accuracy. Main pancreatic duct involvement and rate of HGD or IC were assessed using meta-regression. Summary receiver operating characteristics curves were generated. The area under the curve (AUC) was calculated as overall test performance.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Diagnostic accuracy of serum CA19.9 (\u226537 U\/mL), reported as pooled sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratios (NLR), diagnostic odds ratio (DOR), and AUC and their 95% CIs. Pathology was considered as reference standard.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Overall, 24 studies assessing 5281 patients with IPMN were included. Mean age was 64.7 (95% CI, 62.24-67.10) years, and 2919 patients (55%) were male. Serum CA19.9 data were available for 4653 patients (88.1%), with 966 patients (20.8%) showing elevated levels. Pooled estimates of diagnostic accuracy for HGD or IC (present in 1939 patients [41.7%]) demonstrated sensitivity of 0.35 (95% CI, 0.29-0.43), specificity of 0.90 (95% CI, 0.87-0.92), PLR of 3.37 (95% CI, 2.56-4.44), NLR of 0.72 (95% CI, 0.65-0.80), DOR of 4.67 (95% CI, 3.26-6.70), and AUC of 0.78 (95% CI, 0.74-0.82).<\/jats:p>\n <\/jats:sec>\n \n Conclusions And Relevance<\/jats:title>\n In this systematic review and meta-analysis, CA19.9 with the current cutoff (37 U\/mL) demonstrated poor performance in excluding HGD or IC and only modest value for ruling in IC. These findings suggest CA19.9 should not be used as a standalone or screening test, while its limited rule-in value may aid decision-making in patients with moderate pretest probability. Future studies should investigate whether different cutoffs and dynamic trends could improve diagnostic accuracy.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.17587","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:31:48Z","timestamp":1782487908000},"page":"e2617587","source":"Crossref","is-referenced-by-count":1,"title":["Serum CA19.9 for Detecting High-Grade Dysplasia and Invasive Carcinoma in Patients With Intraductal Papillary Mucinous Neoplasm"],"prefix":"10.1001","volume":"9","author":[{"given":"Charlotte A.","family":"Leseman","sequence":"first","affiliation":[{"name":"Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands"},{"name":"Cancer Center Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro M.","family":"Bonomi","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands"},{"name":"Cancer Center Amsterdam, Amsterdam, the Netherlands"},{"name":"General Surgery Unit, ASST Brianza\u2013Vimercate Hospital, Vimercate, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Job","family":"Schuitema","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands"},{"name":"Cancer Center Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Granieri","sequence":"additional","affiliation":[{"name":"ASST Grande Ospedale Metropolitano Niguarda, Acute Care and Trauma Surgery, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"S\u00e4llberg Chen","sequence":"additional","affiliation":[{"name":"Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Sweden"},{"name":"Medical Unit Cell Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay V.","family":"Maker","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Surgical Oncology, University of California San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeeshan","family":"Ateeb","sequence":"additional","affiliation":[{"name":"Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura D.","family":"Wood","sequence":"additional","affiliation":[{"name":"Departments of Pathology and Oncology, Soman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rogier P.","family":"Voermans","sequence":"additional","affiliation":[{"name":"Cancer Center Amsterdam, Amsterdam, the Netherlands"},{"name":"Amsterdam UMC, location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands"},{"name":"Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Marchegiani","sequence":"additional","affiliation":[{"name":"Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Del Chiaro","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora"},{"name":"University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes C. 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