SERUM TUMOR-MARKERS FOR THE DIAGNOSIS OF CHOLANGIOCARCINOMA IN PRIMARY SCLEROSING CHOLANGITIS

Background/Aims: The diagnosis of cholangiocarcinoma in primary sclero sing cholangitis (PSC), even with the use of current imaging technique s and brush cytology, is difficult and particularly important in patie nts being assessed for liver transplantation. This study investigated the accuracy of serum levels of a combination of the tumor markers car cinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) in the diagnosis of cholangiocarcinoma in patients with PSC. Methods: Sev enty-four patients with PSC were studied. Fifteen patients had tumors (11 occult on imaging), 22 had severe PSC that necessitated transplant ation (with explanted liver known to be free of tumor), and 37 patient s had stable PSC. Results: An index of the two serum tumor markers [us ing the formula CA19-9 + (CEA X 40)] gave an accuracy of 86% in diagno sis of cholangiocarcinoma, with 10 of the 15 cases of cholangiocarcino ma having an increased value compared with none in a group of 22 compa rable cases with no tumor. In addition, 6 of the 11 patients with occu lt tumors had abnormal values. Ultrasonography, computerized tomograph ic scanning, and endoscopic retrograde cholangiopancreatography were p oor predictors of the presence of tumor. Conclusions: A combination of serum tumor markers will identify most occult tumors and will improve selection of appropriate cases for orthotopic liver transplantation.