title: Roles of serum and biliary CEA, CA19-9, VEGFR3, and TAC in differentiating between malignant and benign biliary obstructions.
abstract: OBJECTIVE
  Despite the presence of many diagnostic methods, the differential diagnosis between benign and malignant biliary obstructions is still not easy. We aimed to evaluate the role of serum/biliary carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), vascular endothelial growth factor receptor-3(VEGFR-3), and total antioxidant capacity (TAC) tests in this differential diagnosis.
  
  
  METHODS
  Patients (n:225; 110♂, 115♀) with diagnosis of malignant (n:96) or benign (n:129) biliary obstruction were included in this cross-sectional study. Serum and biliary CEA, CA 19-9, VEGFR-3, and TAC tests were analyzed, statistics were obtained, and significance was defined as p<0.05.
  
  
  RESULTS
  Mean age was 54.9±16.4 for the benign and 54.2±19.6 for the malignant group (p=0.89). Head of pancreas cancer (18.2%), cholangiocarcinoma (11.4%) and choledochal stone (48%) were the most common etiologies. The area under the curve (AUC)s by ROC analysis of serum/biliary CA 19-9, VEGFR-3, and TAC and serum CEA were 0.701/0.616, 0.622/0.663, 0.602/0.581, and 0713, respectively. Serum TAC had higher sensitivity (61.1%) and CEA had lower sensitivity (42.7%), whereas CEA had higher specificity (89.9%) and TAC had lower specificity (60.5%). In biliary tumor markers, CA 19-9 had higher sensitivity (74%) and VEGFR-3 had lower sensitivity (56.2%); however, VEGFR-3 had higher specificity (79.1%) and CA 19-9 had lower specificity (34.1%). Additionally, combination of serum CEA (p<0.001), CA 19-9 (p<0.001), VEGFR-3 (p<0.001), and biliary CA 19-9 (p=0.028) markers achieved 95% estimation probability, and the sensitivity, specificity, and accuracy were 88.5%, 45.7%, and 64%, respectively.
  
  
  CONCLUSIONS
  Serum and biliary CEA, CA 19-9, VEGFR-3, and TAC tests would not be useful in the differentiation between malignant and benign biliary obstructions.
authors.affiliation: Department of Gastroenterology, Bezmialem Vakif University Medical Faculty, İstanbul, Turkey. dralince@gmail.com.
authors.forename: Ali Tüzün
authors.initials: AT
authors.lastname: Ince
authors.forename: Kemal
authors.initials: K
authors.lastname: Yıldız
authors.forename: Birol
authors.initials: B
authors.lastname: Baysal
authors.forename: Ahmet
authors.initials: A
authors.lastname: Danalıoğlu
authors.forename: Orhan
authors.initials: O
authors.lastname: Kocaman
authors.forename: Mukaddes
authors.initials: M
authors.lastname: Tozlu
authors.forename: Venkatanarayana
authors.initials: V
authors.lastname: Gangarapu
authors.forename: Ahu
authors.initials: A
authors.lastname: Sarbay Kemik
authors.forename: Ömer
authors.initials: Ö
authors.lastname: Uysal
authors.forename: Hakan
authors.initials: H
authors.lastname: Şentürk
mesh_terms: D000328:Adult; D000368:Aged; D000975:Antioxidants / Q000032:analysis*; D019540:Area Under Curve; D001646:Bile / Q000737:chemistry; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000175:diagnosis; D001653:Bile Ducts, Intrahepatic; D014408:Biomarkers, Tumor / Q000032:analysis* / Q000097:blood; D018395:CA-19-9 Antigen / Q000032:analysis* / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000032:analysis* / Q000097:blood; D018281:Cholangiocarcinoma / Q000150:complications* / Q000175:diagnosis; D002779:Cholestasis / Q000209:etiology*; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D042882:Gallstones / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000175:diagnosis; D012372:ROC Curve; D040321:Vascular Endothelial Growth Factor Receptor-3 / Q000032:analysis* / Q000097:blood
chemical_list: D000975:Antioxidants; D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; C581309:FLT4 protein, human; D040321:Vascular Endothelial Growth Factor Receptor-3