The Value Of Endoscopic Retrograde Brush Cytology, Forceps Biopsy And CEA, CA242 In The Diagnosis Of Cholangiocarcinoma

Aims It is easy to diagnose cholangiocarcinoma through ultrasonic, CT, ERCP, MRCP, PTC and other imaging devices. However, the diagnosis relying solely on the clinical and imaging symptoms is not reliable due to the possibility that biliary inflammation, damnification, malformation, calculi, tuberculosis and other diseases may have the same imaging symptoms with cholangiocarcinoma. In order to improve the rate of diagnostic accuracy, this research dealed with the value of endoscopic retrograde brush cytology(ERBC), endoscopic retrograde forceps biopsy(ERFB), CEA and CA242 in serum and bile to the Diagnosis of Cholangiocarcinoma.Methods In the ERCP operation of 41 cases of patients suffering from biliary stricture, adapt the operation of ERBC and ERFB, keeped the samples of their bile and serum, measured their CEA and CA242. 30 cases were diagnosed as cholangiocarcinoma and 11 as benign biliary stricture after the operation or the clinical follow-up visits.Results1. Adopting the methods of ERBC, 11 of the 30 cases were confirmed,, the rate of the positive was 36. 7%;Adopting the methods of ERFB, 13 cases were confirmed, the rate of the positive was 43.3%;Combining the two methods, the rate of the positive was 64.1%.2. The serum levels of CEA in the group of cholangiocarcinoma and the group of benign biliary stricture were 5.71±6.1ng/ml and 4.33 ±4.27 ng/ml respectively(P=0.391,>0.05);The serum levels of CA242 were88. 28±78. 03U/ml and 17. 84 + 17. 80 U/ml respectively (P=0. 001, <0. 01). The bile levels of CEA were 72.32 + 66.13 ng/ml and 12.09+12.85 ng/ml respectively (P=0. 006, <0. 01);The bile levels of CA242 were 170. 06 + 70. 90 U/ml and 176. 49±66. 38 U/ml respectively (P=0. 745, >0. 05).3. The area under the ROC curve(AUC) of the serum CEA and CA242, the bile CEA and CA242 are 0.570 (P=0. 499, >0. 05) , 0. 856(P=0. 002, <0. 01), 0. 759(P=0. 012, <0.05), and 0. 491 (P=0.930, >0. 05) respectively, serum CA242 AUC > bile CEA AUC > serum CEA AUC > bile CA242 AUC.4. Of the 41 cases, The sensitivity of serum CEA and CA242 was 56. 7 % and 80.0% respectively;the specificity was 63.6% and 81.8%. The sensitivity of bile CEA and CA242 was 66. 7% and 46. 7% respectively, the specificity was 72.7% and 63.6% respectively.5. When both the serum CA242 and the bile CEA was positive, the sensitivity and the specificity resulted from the combination of the two methods of examination are 53. 4% and 95. 0% respectively. When both the serum CA242 and the bile CEA was positive, and combined with the operations of ERBC and ERFB, the sensitivity and the specificity was 83. 3% and 95. 0 % respectively.Conclusion1. The combined adoption of ERBC and ERFB can improve the rate of the positive in the diagnosis of cholangiocarcinoma, it has great value in the diagnosis of cholangiocarcinoma. 2. The serum CA242 and the bile CEA are both effective in the diagnosis of the sensitivity and the specificity of cholangiocarcinoma, they may be used as tumour marker in the diagnosis of cholangiocarcinoma. The examination of the serum CEA or the bile CA242 has no clinical role. 3. When both the serum CA242 and the bile CEA are positive in the combined examination, the specificity is markedly improved in the diagnosis of cholangiocarcinoma, but the sensitivity goesdown a little;4. When ERBC and ERFB are combined with serum CA242 and bile CEA, they can supplement each other and markedly improve the the sensitivity and the specificity in the diagnosis of cholangiocarcinoma.