| Objective：To investigate the diagnostic value of the concentrations of bile and serumalpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen19-9(CA19-9) and carbohydrate antigen72-4(CA72-4) for distinguishing malignant frombenign extrahepatic biliary obstruction.Methods：Ruling out the others but the pancreatobiliary tumors past and present, the studywas performed prospectively on40patients admitted for ERCP, who suffered fromextrahepatic biliary obstruction confirmed by MRCP or CT. The bile (collected in theprocess of ERCP) and serum (collected from peripheral blood at the same time)concentrations of AFP, CEA, CA19-9and CA72-4were measured from22patientswith benign (including16cases of gallstones,3cases of sphincter of oddi dysfunction,2cases of primary sclerosing cholangitis, and1case of iatrogenic bile duct injury)and18with malignant (including5cases of cholangiocarcinoma,5cases of ampullarycarcinoma, and8cases of pancreatic head carcinoma) extrahepatic biliary obstruction.The tumor markers’ concentrations of these16groups were calculated and werecompared between bile and serum in the benign or malignant obstruction, as well asbetween benign and malignant obstruction in the bile or serum. The tumor markerswhich were of statistical difference between benign and malignant obstruction wereobtained by statistical analysis and a diagnostic algorithm was established withpredicted probability which was suggested by some values of the covariatesmultiplied with the parameter estimates, and passed back through the link function.Then the receiver-operating characteristic (ROC) curves were drawn, respectively, to analyze and compare their diagnostic value.Results：The concentrations (μg/L) of benign bile, benign serum, malignant bile, andmalignant serum AFP were0.40(0.40,0.73),3.50(1.70,3.93),0.50(0.40,1.00), and3.50(1.58,4.28), respectively. The concentrations (μg/L) of benign bile, benign serum,malignant bile, and malignant serum CEA were113.65(2.13,26.10),2.25(1.90,5.50),17.50(3.50,110.90), and5.05(3.55,7.55), respectively. The concentrations (U/ml) ofbenign bile, benign serum, malignant bile, and malignant serum CA19-9were18676.27(212.55,32997.39),27.90(11.34,210.93),22709.04(699.21,120287.74), and304.70(29.19,735.41), respectively. The concentrations (U/ml) of benign bile, benignserum, malignant bile, and malignant serum CA72-4were1.50(0.64,2.48),1.55(1.22,2.95),8.08(2.96,37.66), and1.76(1.44,2.94), respectively. Benign bile AFPwas significantly lower than benign serum AFP; malignant bile AFP was significantlylower than malignant serum AFP; benign bile CEA was significantly higher thanbenign serum CEA; malignant bile CEA was significantly higher than malignantserum CEA; benign bile CA19-9was significantly higher than benign serum CA19-9;malignant bile CA19-9was significantly higher than malignant serum CA19-9;malignant bile CA72-4was significantly higher than malignant serum CA72-4.Benign bile CA72-4was significantly lower than malignant; benign serum CEA waslower than malignant; benign serum CA19-9was lower than malignant. Because ofthe statistical differences of bile CA72-4, serum CEA and serum CA19-9betweenbenign and malignant obstruction, the three markers were chosen for the furtheranalysis. The sensitivity and specificity of bile CA72-4, serum CEA, serum CA19-9,the combination of bile CA72-4and serum CEA, the combination of bile CA72-4andserum CA19-9, the combination of serum CEA and serum CA19-9and thecombination of bile CA72-4, serum CEA and serum CA19-9were (%)83.33,83.33,61.11,100.00,66.67,38.89and50.00, and77.27,68.18,81.82,54.55,86.36,100.00and100.00for diagnosing malignant extrahepatic biliary obstruction, respectively. InROC curve analysis the area under the curve of bile CA72-4, serum CEA, serum CA19-9, the combination of bile CA72-4and serum CEA, the combination of bileCA72-4and serum CA19-9, the combination of serum CEA and serum CA19-9andthe combination of bile CA72-4, serum CEA and serum CA19-9was0.826,0.726,0.732,0.818,0.831,0.727and0.823, respectively, with no statistical differencebetween any two area.Conclusion：Bile AFP or serum AFP can not be applied to distinguishing malignant frombenign extrahepatic biliary obstruction. Bile CA72-4, serum CEA and serum CA19-9can be applied to distinguishing malignant from benign extrahepatic biliaryobstruction. The diagnostic value of bile CA72-4, serum CEA, serum CA19-9, thecombination of bile CA72-4and serum CEA, the combination of bile CA72-4andserum CA19-9, the combination of serum CEA and serum CA19-9and thecombination of bile CA72-4, serum CEA and serum CA19-9was moderate fordistinguishing malignant from benign extrahepatic biliary obstruction with nostatistical difference between any two methods, serving as a complementary role and areference method. |
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