Preoperative diagnosis of extrahepatic cholangiocarcinoma: Application of CA19ª²9 and imaging

    QIN Xingª²Lei1, WANG Zuoª²Ren1, QIANG Yongª²Qian2, WEI Xiaoª²Feng3, ZHANG Yiª²Li2, ZHANG Yunª²Feng1, MA Wei1

    1Department of Hepatobiliary Surgery, 2Center of Imaging, First Hospital, Xi¬ðan Jiaotong University, Xi¬ðan 710061, China, 3Center of Imaging, Luoyang Center Hospital, Luoyang 471009, China

    ¡¾Abstract¡¿ AIM: To explore the preoperative diagnostic value of different imaging methods, CA19ª²9 determination and CEA determination in diagnosing extrahepatic cholangiocarcinoma (EHCC). METHODS: The diagnostic efficacy of various imaging methods was analyzed retrospectively in 107 patients with EHCC. We measured CA19ª²9 and CEA concentrations of serum and bile in patients with EHCC (n=51) and benign biliary diseases (n=42). A receiver operation characteristic (ROC) curve was used to define a new strategy for interpreting CA19ª²9 and CEA in EHCC. RESULTS: The preoperative diagnostic accuracy rates of tumor visualization of ultrasonography (US), computed tomography (CT) and magnetic resonance imaging cholangiopancreatography (MRCP) in diagnosing EHCC were 70.8%, 60.2% and 69.0%, respectively. The diagnostic accuracy rates of tumor location of US, CT, MRCP, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) in diagnosing EHCC were 72.9%, 75.9%, 100%, 71.4% and 76.9%, and the diagnostic accuracy rates for tumor quality were 70.8%, 73.5%, 86.2%, 61.9% and 58.3%, respectively. The serum CA19ª²9 and serum CEA concentrations significantly elevated (P<0.01 and P<0.05) in patients with EHCC compared with those in patients with benign biliary diseases. The ROC curves analysis showed that the area under the ROC curve(AUC)of serum CA19ª²9, serum CEA, and bile CA19ª²9 were 0.942 (P<0.001), 0.516 (P>0.05) and 0.746 (P<0.01), respectively. The outcome showed that the serum and bile CA19ª²9 were of better diagnostic value than serum CEA. The sensitivity of serum CA19ª²9, serum CEA, bile CA19ª²9 and bile CEA in diagnosing EHCC were respectively 86%, 26%, 50% and 32%, and the corresponding specificity when compared with those of the benign biliary disease group were 88%, 95%, 94% and 61%, respectively. CONCLUSION: MRCP is superior to US, CT, ERCP and PTC in locating the position and the nature of the tumor. The determination of serum CA19ª²9 is a reliable test for the differential diagnosis of EHCC. The preoperative diagnosis of EHCC can be performed by two steps: The first is to screen out all patients by US, and the second is to locate the tumor by serum CA19ª²9 determination and MRCP or CT. ......