Gallbladder bile tumor marker quantification for detection of pancreato-biliary malignancies.
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.
Brockmann
J
J
Klinik und Poliklinik für Allgemeine Chirurgie der Westfälischen Wilhelms-Universität Münster, Waldeyerstr. 1, 48149 Münster, Germany. brockmj@uni-muenster.de
Emparan
C
C
Hernandez
C A
CA
Sulkowski
U
U
Dietl
K H
KH
Menzel
J
J
Wolters
H
H
Glodny
B
B
Senninger
N
N
D015295:Antigens, Tumor-Associated, Carbohydrate / Q000378:metabolism; D001652:Bile Ducts / Q000378:metabolism*; D001661:Biliary Tract Neoplasms / Q000175:diagnosis* / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000378:metabolism*; D018394:CA-125 Antigen / Q000378:metabolism; D018395:CA-19-9 Antigen / Q000378:metabolism; D002272:Carcinoembryonic Antigen / Q000378:metabolism; D005704:Gallbladder / Q000378:metabolism; D006801:Humans; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000378:metabolism; D011379:Prognosis
D015295:Antigens, Tumor-Associated, Carbohydrate; D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D018395:CA-19-9 Antigen; C083825:CA-72-4 antigen; D002272:Carcinoembryonic Antigen