Brockmann J, Emparan C, Hernandez C A, Sulkowski U, Dietl K H, Menzel J, Wolters H, Glodny B, Senninger N
Klinik und Poliklinik für Allgemeine Chirurgie der Westfälischen Wilhelms-Universität Münster, Waldeyerstr. 1, 48149 Münster, Germany.
Anticancer Res. 2000 Nov-Dec;20(6D):4941-7.
The pre-operative differentiation of tumors of the pancreas, Papilla of Vater and the biliary tract is still unsatisfactory. Tumor marker analysis of the pancreatic juice did not improve the pre-operative diagnosis by a great deal.
Bile from resected gallbladders of patients suffering from carcinomas of the pancreato-biliary system was analysed for CA 19-9, CEA, CA 72-4, CA 125 and AFP concentrations. The results were compared to patients suffering from acute cholecystitis, cholecystolithiasis as well as those suffering from benign tumors of the pancreato-biliary region.
Extreme high CA 19-9 concentrations were found in bile. Evaluations of the tumor-antigens CA 19-9, CA 72-4 and CEA in gallbladder bile were superior to any serum and pancreatic juice examination with respect to sensitivity and specificity. Observed sensitivities amounted to 100% for patients suffering from bile duct carcinoma (CA 19-9) and papillary carcinoma (CEA) at a specificity of 100%. CA 19-9 showed a sensitivity of 76.5% for pancreatic carcinomas at a specificity of 96.4%. CA 19-9 showed significant differences for the local tumor burden and for the degree of lymph node metastasis. Examination of tumor antigens in the gallbladder results in a high degree of discrimination for malignant and benign lesions of the subhepatic pancreato-biliary system.
CA 19-9 must follow a entero-hepatic circulation, since it showed raised bile concentrations (factor: 10(4)) compared to serum analysis. Analysis of CA 19-9, CEA and CA 72-4 gives an opportunity for improvement in the detection of cancers of the pancreato-biliary system. Since the clinical important differentiation of tumors of the head of the pancreas (carcinoma vs. pancreatitis) remains unclear, an improvement by bile analyses must be assumed.
胰腺、 Vater 壶腹和胆道肿瘤的术前鉴别诊断仍不尽人意。胰液的肿瘤标志物分析并未显著改善术前诊断。
对胰胆系统癌患者切除胆囊的胆汁进行 CA 19-9、癌胚抗原（CEA）、CA 72-4、CA 125 和甲胎蛋白（AFP）浓度分析。将结果与急性胆囊炎、胆囊结石患者以及胰胆区域良性肿瘤患者进行比较。
胆汁中发现 CA 19-9 浓度极高。胆囊胆汁中肿瘤抗原 CA 19-9、CA 72-4 和 CEA 的评估在敏感性和特异性方面优于任何血清和胰液检查。胆管癌（CA 19-9）和乳头状癌（CEA）患者的观察敏感性为 100%，特异性为 100%。CA 19-9 对胰腺癌的敏感性为 76.5%，特异性为 96.4%。CA 19-9 在局部肿瘤负荷和淋巴结转移程度方面存在显著差异。胆囊中肿瘤抗原的检测对肝下胰胆系统的恶性和良性病变具有高度鉴别力。
CA 19-9 必定遵循肠肝循环，因为与血清分析相比，其胆汁浓度升高（系数：10⁴）。CA 19-9、CEA 和 CA 72-4 的分析为改善胰胆系统癌症的检测提供了机会。由于胰腺头部肿瘤（癌与胰腺炎）的临床重要鉴别仍不明确，必须假定胆汁分析能带来改善。
