Diagnostic Value On Joint Detection For Tumor Markers CA19-9, CA72-5 In Bile To Cholangiocarcinoma

PurposeCholangiocarcinoma, which is a common gastrointestinal tumor, is epithelioma occurring in the intrahepatic or extrahepatic bile duct. In recent years, the incidence rate of cholangiocarcinoma has increased year by year. The symptoms of this disease is concealed and has a low diagnostic rate in the early stage. Although the imaging technology has been developing continuously, sorts of diseases such as inflammation, injury,deformity,calculus, have the same clinical and imaging manifestation with that of cholangiocarcinoma. So it is not so reliable to make a diagnosis only based on the clinical and imaging examination results. Tumor marker is the specific substance intrinsically existing in the tumor cells or secreted by tumor cells. The bile, as the microenvironment for bile duct tumor cells to grow, the relevant protein secreted and detached from tumor cell gathers here. The factors within the cell body can be excluded, thus the detection of relevant antigen in the bile becomes the focus in research. However, at present, there is no any marker,which is specific and sensitive at home and abroad to make etiologic diagnosis to cholangiocarcinoma. The proper assembly of various makers can make up for each other's deficiencies and enhance the sensitivity and specialty of diagnosis. Serum CEA, CA19-9, CA72-4 are commonly used as tumor maker in the digestive system, it has been widely employed to auxiliary diagnosis of gastric cancer and colorectal carcinoma. Yet the diagnosis value of CA19-9, CA72-4 and CEA in the bile to cholangiocarcinoma has been not so evident. In order to enhance Qualitative occurence of diagnosis of cholangiocarcinoma prior to operation, this research discusses diagnosis value of joint detection and single detection of CEA, CA19-9, and CA72-4 in bile in ERCP to cholangiocarcinoma. MethodsThe cases of 45 patients suffering from biliary tract disease are collected. In the cases, the number of patients with biliary benign tract disease is 20, and that of cholangiocarcinoma patients are 25. All patients need to be drawn fasted venous blood about 3 ml prior to ERCP. ECLIA is used to examine the level of markers CEA,CA19-9,CA72-4 in serum. Bile sample with a volume of round 5 ml is draw from angiographic catheter in the process of ERCP surgery. Similarly, ECLIA is used to examine the level of the tumor marker mentioned above in bile. The malignant cases can be diagnosed by pathological results after surgery or cytology examination of bile, cell brush examination or clinical follow-ups. The reference range of the positive result in serum can be determined in accordance with reference value provided by the kit. The dividing values of positive result for CEA,CA19-9,CA72-4 in serum are 3.4ng/L,39U/L,6.9U/L respectively. The measured content of CA19-9,CA72-4 and CEA in all cases in serum is used to analyze measured results of cholangiocarcinoma group and biliary duct benign pathology group to determine the top and bottom limitation, group interval and cut-off point of individual measured values. In accordance with distribution table of cumulative frequency of the selected group intervals, the sensitivity and specialty of all cut-off points is calculated out respectively. The highest cut-off point as the sum of sensitivity and specialty is taken as the cutoff value of each index, namely the positive dividing value. Through calculation ,the dividing value of CEA,CA19-9,CA72-4 in the bile is 53mg/L,1000U/L,24U/L respectively. The values greater than or equal to the positive dividing value is positive, The values less than the positive dividing value is negative. The comparison of differences of level of CA19-9,CEA,CA72-4 between patients of malignant group and the patients of benign group, and of the differences of level of CA19-9,CEA,CA72-4 in serum and bile of malignant and benign patients of bile duct disease, and of between the joint detection of CEA,CA19-9,CA72-4 in bile and the detection of random combination of both materials and single detection for sensitivity and specialty of diagnosis of cholangiocarcinoma draws the following conclusions.ResultsCEA in serum of cholangiocarcinoma group and benign bile duct disease group is .95±2.58ng/m1,1.904±1.646ng/ml(P=0.0492,<0.05) respectively. The statistical significance of difference is available. CEA in serum of cholangiocarcinoma group is obviously higher than that of benign bile duct disease group. CA19-9 in serum is 227.2±287.9U/mL,189.8±346.4 U/L(P=0.443, >0.05) respectively, The statistical significance of difference is not available. CA72-4 in serum is 3.12±5.31U/m1, 1.3±1.299U/L (P=0.1425, >0.05). The statistical significance of difference is not available. CEA in bile of cholangiocarcinoma group and benign bile duct disease group is 60.44±79.79ng/ml, 23.26±15.38ng/ml(P=0.0403,<0.05) respectively. The statistical significance of difference is available. CA19-9 in bile is 3269.44±3499.76U/ml,944.83±772.44U/ml( P=0.0055, <0.01). CA19-9 in bile of cholangiocarcinoma group is obviously higher than that of benign bile duct disease group. The statistical significance of difference is available. CA72-4 in bile is 68.77±87.18 U/ml,16.61±14.87 U/m(lP=0.0114,<0.05)respectively. CA72-4 in bile of cholangiocarcinoma group is obviously higher than that of benign bile duct disease group. The statistical significance of difference is available. Level of tumor marker in patients of cholangiocarcinoma group is obviously higher than that of serum (P<0.05), the statistical significance of difference is available. The level of tumor marker in bile of benign bile duct disease group is obviously higher than that of serum (P<0.05). The statistical significance of difference is available. In 45 cases, sensitivity, specialty, accuracy, false positive rate, false negative rate, positive predictive value, negative predictive value in bile of CEA diagnosis is 52%, 95%, 71.1%, 5%, 48%, 93%, 61.3% respectively. Sensitivity, specialty, accuracy, false positive rate, false negative rate, positive predictive value, negative predictive value in bile of CA19-9 diagnosis is 92%, 60%, 40%, 78.9%, 8%, 74.2% , 86% respectively. Sensitivity, specialty, accuracy, false positive rate, false negative rate, positive predictive value, negative predictive value in bile of CA CA72-4diagnosis is 72%, 80%, 75.6%, 20%, 28%, 82%, 79.6% respectively. Different ways of combination of bile tumor marker can be applied to detect jointly sensitivity and specialty in malignant patients. After the CEA and CA19-9 in bile are jointly detected, the sensitivity and specialty of serial tests is 62%, 90% respectively, and the sensitivity and specialty of parallel test is 92%,55% respectively. After CEA and CA72-4 are jointly detected, the sensitivity and specialty of serial tests is 58% and 95 % respectively, and the sensitivity and specialty of parallel test is 68% and 70% respectively. After CA19-9 and CA72-4 are jointly detected, the sensitivity and specialty of serial tests is 70% and 85% respectively, and the sensitivity and specialty of parallel test is 96% and 50% respectively. After the CEA and CA19-9 and CA72-4 are jointly detected, the sensitivity and specialty of serial tests is 76% and 95% respectively, and the sensitivity and specialty of parallel test is 96% and 70% respectively.Conclusions1. The tumor marker CEA in serum or CEA,CA19-9,CA72-4 in bile can be taken as the valid indicator to diagnose cholangiocarcinoma.2. Detecting level of CA19-9,CA72-4,CEA in bile is helpful to identify and diagnose the benign and malignant pathology in biliary duct.3. Joint detection CA19-9+CA72-4+CEA in bile is helpful to improve the diagnostic efficiency of benign and malignant biliary duct diseases.