title: Value of CEA level determination in gallbladder bile in the diagnosis of liver metastases secondary to colorectal adenocarcinoma.
abstract: BACKGROUND
  The relevance of colorectal adenocarcinoma lies in its high incidence, with the liver being the organ most frequently affected by distant metastases. Liver metastases occur in 40 to 50% of patients with colorectal adenocarcinoma, accounting for approximately 80% of deaths in the first three postoperative years. Nevertheless, despite this, they are occasionally susceptible to curative treatment.
  
  
  OBJECTIVE
  The present investigation focused on the relationship between the level of carcinoembryonic antigen (CEA) in gallbladder bile and the presence of liver metastases secondary to colorectal adenocarcinoma.
  
  
  METHODS
  Diagnostic test study.
  
  
  METHODS
  Surgical Gastroenterology Discipline at the São Paulo Hospital, São Paulo, Brazil.
  
  
  METHODS
  Forty-five patients with colorectal adenocarcinoma were studied, 30 without liver metastases (group I), and 15 with liver metastases (group II). Diagnosis of liver metastases was made through computed tomography, magnetic resonance imaging and computed tomography during arterial portography. Samples of peripheral blood, portal system blood, and gallbladder bile were collected from patients during the surgical procedure. A control group composed of 18 organ donors underwent the same material collection procedures. CEA level determination was made through fluoroimmunoassay.
  
  
  RESULTS
  Mean CEA value in peripheral serum was 2.0 ng/ml (range: 0.7 to 3.8 ng/ml) in the control group, 11.4 ng/ml (range: 0.5 to 110.3 ng/ml) in group I, and 66.0 ng/ml (range: 2.1 to 670 ng/ml) in group II. In the portal system, serum mean values found were 1.9 ng/ml (range: 0.4 to 5.0 ng/ml) in the control group, 15.3 ng/ml (range: 0.8 to 133.3 ng/ml) in group I, and 70.8 ng/ml (range: 1.8 to 725 ng/ml) in group II. Mean values found in gallbladder bile were 4.1 ng/ml (range: 1.0 to 8.6 ng/ml) in the control group, 14.3 ng/ml (range: zero to 93.0 ng/ml) in group I, and 154.8 ng/ml (range: 14.0 to 534.7 ng/ml) in group II.
  
  
  CONCLUSIONS
  The CEA level in gallbladder bile is elevated in patients with liver metastases. Determination of CEA both in peripheral serum and in gallbladder bile enabled patients with liver metastases to be distinguished from those without such lesions. The level of CEA in gallbladder bile, however, seems to lead to a more accurate diagnosis of liver metastases secondary to colorectal adenocarcinoma.
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil. ritmoura@sti.com.br
authors.forename: R M
authors.initials: RM
authors.lastname: Moura
authors.forename: D
authors.initials: D
authors.lastname: Matos
authors.forename: M M
authors.initials: MM
authors.lastname: Galvão Filho
authors.forename: G
authors.initials: G
authors.lastname: D'Ippólito
authors.forename: J
authors.initials: J
authors.lastname: Sjzenfeld
authors.forename: L M
authors.initials: LM
authors.lastname: Giuliano
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000175:diagnosis* / Q000556:secondary*; D000328:Adult; D000368:Aged; D001646:Bile / Q000737:chemistry*; D002272:Carcinoembryonic Antigen / Q000032:analysis* / Q000097:blood; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
chemical_list: D002272:Carcinoembryonic Antigen