Gallbladder bile tumor marker quantification for detection of pancreato-biliary malignancies

Anticancer Res. Nov-Dec 2000;20(6D):4941-7.

Abstract

Background: The pre-operative differentiation of tumors of the pancreas, Papilla of Vater and the biliary tract is still unsatisfactory. Tumor marker analysis of the pancreatic juice did not improve the pre-operative diagnosis by a great deal.

Methods: Bile from resected gallbladders of patients suffering from carcinomas of the pancreato-biliary system was analysed for CA 19-9, CEA, CA 72-4, CA 125 and AFP concentrations. The results were compared to patients suffering from acute cholecystitis, cholecystolithiasis as well as those suffering from benign tumors of the pancreato-biliary region.

Results: Extreme high CA 19-9 concentrations were found in bile. Evaluations of the tumor-antigens CA 19-9, CA 72-4 and CEA in gallbladder bile were superior to any serum and pancreatic juice examination with respect to sensitivity and specificity. Observed sensitivities amounted to 100% for patients suffering from bile duct carcinoma (CA 19-9) and papillary carcinoma (CEA) at a specificity of 100%. CA 19-9 showed a sensitivity of 76.5% for pancreatic carcinomas at a specificity of 96.4%. CA 19-9 showed significant differences for the local tumor burden and for the degree of lymph node metastasis. Examination of tumor antigens in the gallbladder results in a high degree of discrimination for malignant and benign lesions of the subhepatic pancreato-biliary system.

Conclusions: CA 19-9 must follow a entero-hepatic circulation, since it showed raised bile concentrations (factor: 10(4)) compared to serum analysis. Analysis of CA 19-9, CEA and CA 72-4 gives an opportunity for improvement in the detection of cancers of the pancreato-biliary system. Since the clinical important differentiation of tumors of the head of the pancreas (carcinoma vs. pancreatitis) remains unclear, an improvement by bile analyses must be assumed.

MeSH terms

  • Antigens, Tumor-Associated, Carbohydrate / metabolism
  • Bile Ducts / metabolism*
  • Biliary Tract Neoplasms / diagnosis*
  • Biliary Tract Neoplasms / metabolism
  • Biomarkers, Tumor / metabolism*
  • CA-125 Antigen / metabolism
  • CA-19-9 Antigen / metabolism
  • Carcinoembryonic Antigen / metabolism
  • Gallbladder / metabolism
  • Humans
  • Pancreatic Neoplasms / diagnosis*
  • Pancreatic Neoplasms / metabolism
  • Prognosis

Substances

  • Antigens, Tumor-Associated, Carbohydrate
  • Biomarkers, Tumor
  • CA-125 Antigen
  • CA-19-9 Antigen
  • CA-72-4 antigen
  • Carcinoembryonic Antigen