The value of biliary fibronectin for diagnosis of cholangiocarcinoma.

BACKGROUND/AIMS: The fibronectin in various body fluids was reported to be useful in the differential diagnosis of benign and malignant diseases. We conducted this study to assess the diagnostic value of biliary fibronectin.

METHODOLOGY

Bile was collected from patients with gallstones (n = 62), benign biliary stricture (n = 5) and cholangiocarcinoma (n = 28). All patients with gallstones were complicated with cholangitis. The absolute biliary level of fibronectin was determined by an immunoenzymatric assay and divided by the biliary concentration of bile acids to calculate the relative concentration.

RESULTS

The relative concentration of biliary fibronectin was significantly different among the patients with benign biliary obstruction, gallstone and cholangiocarcinoma (7.1 +/- 14.3 vs. 350.5 +/- 1535.4 vs. 180592.6 +/- 917236.2, p < 0.05). With a cut-off value of 40 ng/mumol, its sensitivity for diagnosing cholangiocarcinoma was 0.57, and specificity, 0.79.

CONCLUSIONS

As bile may be concentrated or diluted to a various extent after biliary obstruction, the relative concentration of biliary fibronectin is more useful than the absolute concentration in differentiating the causes of biliary obstruction. In addition to the presence of biliary cancer, biliary fibronectin was also increased in response to biliary inflammation, which limits its use as a tumor marker of cholangiocarcinoma.