Gallbladder bile tumor marker quantification for detection of pancreato-biliary malignancies

Background: The pre-operative differentiation of tumors of the pancreas, Pa pilla of Vater and the biliary tract is still unsatisfactory. Tumor marker analysis of the pancreatic juice did not improve the pre-operative diagnosi s by a great deal. Methods: Bile from resected gallbladders of patients suf fering 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 wel l as those suffering from benign tumors of the pancreato-biliary region. Re sults: 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 sup erior to any serum and pancreatic juice examination with respect to sensiti vity 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 pancrea tic carcinomas at a specificity of 96.4%. CA 19-9 showed significant differ ences fol the local tumor burden and for the degree of lymph node metastasi s. Examination of tumor antigens in the gallbladder results in a high degre e of discrimination fol malignant and benign lesions of the subhepatic panc reato-biliary system. Conclusions: CA 19-9 must follow a entero-hepatic cir culation, since it showed raised bile concentrations (factor: 10(4)) compar ed to serum analysis. Analysis of CA 19-9 CEA and CA 72-4 gives an opportun ity for improvement in the detection of cancels of the pancreato-biliary sy stem. 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.