Diagnostic role of biliary carcinoembryonic antigen in patients with pancreatobiliary diseases

Choo, Yeon Ik; Joo, Kwang Ro; Park, Jong Ho; Bang, Sung Jo; Kim, Do Ha; Shin, Jung Woo; Park, Neung Hwa; Park, Jae Hoo; Lee, Ji Ho

Abstract

BACKGROUN: Recently there has been notion that fluids bathing tumors might contain higher levels of carcinoembryonic antigen (CEA) than those found in the blood. Thus, we evaluated the diagnostic role of biliary CEA in patients with pancreatobiliary diseases.
METHODS
One hundred and twenty one patients were prospectively studied. The patients were grouped as control (n=21), benign diseases (n=57), and malignant diseases (n=43). All patients underwent endoscopic or percutaneous biliary drainage. Bile was obtained and analyzed for CEA concentration on the next day of biliary drainage procedure.
RESULTS
The mean biliary CEA were significantly different among the groups: control, 3.6 +/- 6.5 ng/mL; benign diseases, 35.4 +/- 59.2 ng/mL; malignant diseases, 77.9 +/- 126.6 ng/mL. But, there was considerable overlap among the groups. With a cut-off level of 22 ng/mL, the sensitivity and specificity were 58.1% and 60.5%, respectively. Among the variables, biliary CEA, total bilirubin, and gamma-GT were directly correlated with presence of malignancy. However, multivariate analysis revealed that biliary CEA was not enough to differentiate malignant diseases from benign diseases.
CONCLUSION
Although biliary CEA levels might be predictive of malignancy, it is very difficult to differentiate with fair certainty between the two diseases because of the considerable overlap. Thus, biliary CEA appears to have a limitation for routine clinical application in distinguishing between benign and malignant diseases.