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25378 Carbohydrate Antigen 19-9, Body Fluid

Carbohydrate Antigen 19-9, Body Fluid
Test Code: CA19-9O
Useful For
An adjunct marker in the assessment of pancreatic cysts when used in conjunction with CEA, amylase, imaging studies and cytology.
An adjuvant to cytology and imaging studies to differentiate between nonmalignant and malignant causes of pleural effusions & peritoneal fluid.
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Pancreatic Cyst Fluid / Body Fluid​ ​Body Fluid container ​Plastic vial ​300 uL ​100 uL ​N/A
Collection Processing Instructions
Do not collect the specimen with preservatives or anticoagulants. Specimens should be centrifuged to remove cells or clots if present.
Specimen Stability Information
Specimen Type Temperature Time
​Pancreatic Cyst Fluid / Body Fluid ​ ​ ​ ​Ambient ​N/A
​Refrigerated ​7 days
​Frozen at -20 deg Celsius ​30 days
​Frozen at -70 deg Celsius ​> 30 days
Rejection Criteria
Blood or Urine
Interference
The possibility exists for interference by heterophile antibodies & HAMA in the patient sample regularly exposed to animals or has received immunotherapy or diagnostic procedures utilizing immunoglobulins or immunoglobulin fragments.
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Marshfield ​Monday through Friday ​Less than 2 hours
Two-step Sandwich Immunoassay using Direct Chemiluminometric Technology/Siemens Centaur ​
Reference Range Information
Performing Location Reference Range
​Marshfield ​Reference cut-off limits for CEA for pancreatic cyst fluid and other body fluids have not been established and verified.

The test results should not be the sole basis of diagnosis and always be correlated with imaging and cytology.
Interpretation
Diagnosis of a pancreatic cyst is often difficult and requires correlation of imaging studies, cytology studies and tumor marker results on cyst aspirates. High concentrations of Carbohydrate antigen 19-9 (CA 19-9) in pancreatic cyst fluid may be helpful in distinguishing between benign and malignant cysts.

Based on evidence available and recommendations by the American College of Gastroenterology (ACG) practice guidelines for the Diagnosis and Management of Neoplastic Pancreatic Cysts (Am. J. Gastroenterol. 2007; 102: 2339-2349), a pancreatic cyst fluid CA 19-9 < 37 U/ml has high specificity to excludes mucinous cyst. A low (<5 U/ml) or negative result may be uninformative or misleading as some individuals do not produce CA 19-9 antigens. Serum CA 19-9 should be measured to verify if a patient is a CA 19-9 secretor or not.

This test should be performed in conjunction with CEA & Amylase and should not be ordered for pancreatic fluid of non-cyst origin.
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​86301 ​ ​ ​ ​
Ordering Applications
Ordering Application Description
COM CA 19-9, Body Fluid
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Pancreatic Cyst Fluid / Body Fluid​ ​Body Fluid container ​Plastic vial ​300 uL ​100 uL ​N/A
Collection Processing
Do not collect the specimen with preservatives or anticoagulants. Specimens should be centrifuged to remove cells or clots if present.
Specimen Stability Information
Specimen Type Temperature Time
​Pancreatic Cyst Fluid / Body Fluid ​ ​ ​ ​Ambient ​N/A
​Refrigerated ​7 days
​Frozen at -20 deg Celsius ​30 days
​Frozen at -70 deg Celsius ​> 30 days
Rejection Criteria
Blood or Urine
Interference
The possibility exists for interference by heterophile antibodies & HAMA in the patient sample regularly exposed to animals or has received immunotherapy or diagnostic procedures utilizing immunoglobulins or immunoglobulin fragments.
Useful For
An adjunct marker in the assessment of pancreatic cysts when used in conjunction with CEA, amylase, imaging studies and cytology.
An adjuvant to cytology and imaging studies to differentiate between nonmalignant and malignant causes of pleural effusions & peritoneal fluid.
Reference Range Information
Performing Location Reference Range
​Marshfield ​Reference cut-off limits for CEA for pancreatic cyst fluid and other body fluids have not been established and verified.

The test results should not be the sole basis of diagnosis and always be correlated with imaging and cytology.
Interpretation
Diagnosis of a pancreatic cyst is often difficult and requires correlation of imaging studies, cytology studies and tumor marker results on cyst aspirates. High concentrations of Carbohydrate antigen 19-9 (CA 19-9) in pancreatic cyst fluid may be helpful in distinguishing between benign and malignant cysts.

Based on evidence available and recommendations by the American College of Gastroenterology (ACG) practice guidelines for the Diagnosis and Management of Neoplastic Pancreatic Cysts (Am. J. Gastroenterol. 2007; 102: 2339-2349), a pancreatic cyst fluid CA 19-9 < 37 U/ml has high specificity to excludes mucinous cyst. A low (<5 U/ml) or negative result may be uninformative or misleading as some individuals do not produce CA 19-9 antigens. Serum CA 19-9 should be measured to verify if a patient is a CA 19-9 secretor or not.

This test should be performed in conjunction with CEA & Amylase and should not be ordered for pancreatic fluid of non-cyst origin.
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Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Marshfield ​Monday through Friday ​Less than 2 hours
Two-step Sandwich Immunoassay using Direct Chemiluminometric Technology/Siemens Centaur ​
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​86301 ​ ​ ​ ​
For most current information refer to the Marshfield Laboratory online reference manual.