Siqueira Eduardo, Schoen Robert E, Silverman William, Martin John, Rabinovitz Mordechai, Weissfeld Joel L, Abu-Elmaagd Kareem, Madariaga Juan R, Slivka Adam
Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Gastrointest Endosc. 2002 Jul;56(1):40-7. doi: 10.1067/mge.2002.125105.
Primary sclerosing cholangitis is a progressive cholestatic liver disease associated with cholangiocarcinoma. Brush cytology and serum tumor markers (carcinoembryonic antigen, carbohydrate antigen 19-9 [CA19-9]) have been used to diagnose cholangiocarcinoma, but there are few data comparing their effectiveness.
The effectiveness of brush cytology, carcinoembryonic antigen, and CA19-9 for the diagnosis of cholangiocarcinoma was retrospectively studied by review of patients with primary sclerosing cholangitis. Receiver operator curves were used to identify cutoff points for carcinoembryonic antigen and CA19-9.
Of 692 patients with primary sclerosing cholangitis screened, adequate follow-up was obtained in 333, 44 (13%) of whom had a diagnosis of cholangiocarcinoma. Three hundred eighteen brush cytology specimens were obtained in 151 patients; serum carcinoembryonic antigen and CA19-9 levels were obtained in 144 and 55 patients, respectively. The overall sensitivity and specificity of brush cytology were, respectively, 46.4% (95% CI [27.5, 64.5]) and 100% (95% CI [97.2, 100]). A carcinoembryonic antigen >5.2 ng/mL had a sensitivity of 68.0% (95% CI [47.5, 83.9]) and specificity of 81.5% (95% CI [73.9, 87.7]). A CA19-9 >180 U/mL had a sensitivity of 66.7% (95% CI [34.9, 87.7]) and specificity of 97.7% (95% CI [88.2, 99.9]). In the subset of patients in which all 3 tests were obtained, (n = 45, cholangiocarcinoma = 8) the combination of an abnormal carcinoembryonic antigen or CA19-9 had the highest sensitivity: 100% (95% CI [65.1, 100.0]) with a specificity of 78.4% (95% CI [63.1, 89.7]). The combination of a positive brush cytology or an abnormal CA19-9 had a sensitivity and specificity of, respectively, 87.5% (95% CI [50.0, 99.4]) and 97.3% (95% CI [86.2, 99.9]).
Screening patients with primary sclerosing cholangitis for cholangiocarcinoma with CA19-9 and carcinoembryonic antigen is reasonable, but the ideal intervals at which to obtain these tests and the cost-effectiveness require further study.
原发性硬化性胆管炎是一种与胆管癌相关的进行性胆汁淤积性肝病。刷检细胞学检查和血清肿瘤标志物（癌胚抗原、糖类抗原19-9 [CA19-9]）已用于诊断胆管癌，但比较它们有效性的数据很少。
通过回顾原发性硬化性胆管炎患者，对刷检细胞学检查、癌胚抗原和CA19-9诊断胆管癌的有效性进行了回顾性研究。采用受试者工作特征曲线确定癌胚抗原和CA19-9的临界值。
在692例接受筛查的原发性硬化性胆管炎患者中，333例获得了充分的随访，其中44例（13%）被诊断为胆管癌。151例患者共获得318份刷检细胞学标本；分别有144例和55例患者检测了血清癌胚抗原和CA19-9水平。刷检细胞学检查的总体敏感性和特异性分别为46.4%（95%可信区间[27.5, 64.5]）和100%（95%可信区间[97.2, 100]）。癌胚抗原>5.2 ng/mL时，敏感性为68.0%（95%可信区间[47.5, 83.9]），特异性为81.5%（95%可信区间[73.9, 87.7]）。CA19-9>180 U/mL时，敏感性为66.7%（95%可信区间[34.9, 87.7]），特异性为97.7%（95%可信区间[88.2, 99.9]）。在所有三项检查均进行的患者亚组中（n = 45，胆管癌 = 8），癌胚抗原或CA19-9异常的联合检测敏感性最高：100%（95%可信区间[65.1, 100.0]），特异性为78.4%（95%可信区间[63.1, 89.7]）。刷检细胞学检查阳性或CA19-9异常的联合检测敏感性和特异性分别为87.5%（95%可信区间[50.0, 99.4]）和97.3%（95%可信区间[86.2, 99.9]）。
用CA19-9和癌胚抗原筛查原发性硬化性胆管炎患者是否患有胆管癌是合理的，但进行这些检查的理想间隔时间和成本效益需要进一步研究。
