Elevated CA19-9 in IgG4-related disease
Bibliographic record
Abstract
Background IgG4-related disease (IgG4-RD) is an inflammatory disease that can clinically mimic pancreatic and hepatobiliary cancer. Serum carbohydrate antigen 19-9 (CA19-9) is a tumour marker that is frequently used to aid in the diagnosis of biliary cancer. There have been reported cases that patients with IgG4-RD also have elevated CA19-9. Methods This study has two components, first, a quality assurance component that observes paired IgG4 and CA19-9 measurements from patients with unknown diagnoses were compared to determine if serum IgG4 interferes with CA19-9 measurement. In addition, a mixing study is used to investigate if high levels of IgG4 interfered with CA19-9 measurements. Second, a retrospective chart review was performed to compare patients diagnosed with IgG4-RD with normal versus elevated CA19-9. Results Among 487 unique individuals with paired measurements, no association between CA19-9 and serum IgG4 was found. Mixing studies revealed no interference. Among 20 patients with IgG4-RD, 11 had elevated CA19-9 (median 150 kU/L) and nine had normal CA19-9. There was no difference in bilirubin between the two groups (63.2 µmol/L vs 39.4 µmol/L, P = .47). Conclusion There is no relationship between CA19-9 and serum IgG4. Patients with IgG4-RD and elevated CA19-9 did not have higher bilirubin than those with normal CA19-9. Together, these results suggest that elevated CA19-9 in IgG4-RD may be related to the disease rather than to interference from high serum IgG4 or from biliary obstruction.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".