PROGNOSTIC AND THERAPEUTIC SCORE FOR COLORECTAL ADENOMAS AND THE ROLEOF SERUM AND TISSUE CARCINOEMBRYONIC ANTIGEN

Objective To study the tissue carcinoembryonic antigen (TCEA) concentr ations with regard to multiplicity, diameter, pathohistological findin g, degree of dysplasia and serum CEA (SCEA) concentrations. Methods Ou r study included 46 patients with single or multiple adenomas, For 56 adenomas TCEA concentrations were measured in addition to standard det erminations of multiplicity, diameter, pathohistology, degree of dyspl asia and SOFA. The measurements of TCEA concentrations were performed using the CEA-EIA method (Abbott) modified for wet tissue obtained fro m the head of the adenoma (TCEA-A), margin of resection at the neck or base of the adenoma (TCEA-B), mucosa near the adenoma (TCEA-C) and re ctal mucosa (TCEA-D), The Mann-Whitney test and M estimates were used to differentiate CEA distribution between various classes of adenomas within each characterization. Results TCEA concentrations from the hea d of the adenoma (TCEA-A) demonstrated highly significant difference b etween mild and severe dysplasia (P = 0,0003), between mild dysplasia and invasive adenocarcinoma (P = 0.001) and significant difference bet ween mild and moderate dysplasia (P = 0,04), There was a statistically significant difference in TCEA-A also between tubular and villous ade nomas (P = 0,04), On the other hand, no significant correlations with regard to multiplicity, diameter and pathohistological features were f ound, Conclusion These results suggest that there is a highly signific ant difference between the tissue CEA concentration from the head of t he adenoma (TCEA-A) in the presence or absence of severe dysplasia, Fu rthermore, combining a number of pathological variables together with TCEA and routine SOFA, a new score was proposed to be used as a guide to the frequency of follow-up colonoscopy following polypectomy. (C) 1 998 Lippincott-Raven Publishers.