Yeatman T J, Bland K I, Copeland E M, Hollenbeck J I, Souba W W, Vogel S B, Kimura A K
Department of Surgery, University of Florida, College of Medicine, Gainesville 32610.
Ann Surg. 1989 Oct;210(4):505-12. doi: 10.1097/00000658-198910000-00011.
While computerized tomographic (CT) scanning and intraoperative exploration are both considered accurate measures of liver involvement with metastatic disease, 10% to 30% of colorectal liver metastases remain undetected. Attempting to improve current methods for detecting colorectal liver metastases, CEA levels in gallbladder bile and serum from patients with known liver metastases were determined. One hundred per cent of patients with single and multiple metastases of various dimensions were observed to have gallbladder bile CEA levels strikingly higher than serum values (4.7 to 259 times greater, p = 0.0009). Linear regression analysis of estimated tumor volume and surface area versus gallbladder bile CEA levels predicted that very small tumors (less than or equal to 1 cm3 in volume) might produce detectable levels (9 to 41 ng/mL) of biliary CEA. For this reason, patients who lack clinical and radiologic evidence of distant metastases at the time of primary colorectal resection but who do have elevated gallbladder bile CEA levels (greater than or equal to 10 ng/mL) are being followed for the appearance of occult hepatic metastases.
虽然计算机断层扫描（CT）和术中探查都被认为是检测肝脏转移性疾病的准确方法，但仍有10%至30%的结直肠癌肝转移灶未被发现。为了改进当前检测结直肠癌肝转移的方法，对已知肝转移患者的胆囊胆汁和血清中的癌胚抗原（CEA）水平进行了测定。观察到所有具有各种大小的单个和多个转移灶的患者，其胆囊胆汁CEA水平均显著高于血清值（高4.7至259倍，p = 0.0009）。对估计的肿瘤体积和表面积与胆囊胆汁CEA水平进行线性回归分析预测，非常小的肿瘤（体积小于或等于1 cm³）可能会产生可检测水平（9至41 ng/mL）的胆汁CEA。因此，在原发性结直肠癌切除时缺乏远处转移的临床和影像学证据，但胆囊胆汁CEA水平升高（大于或等于10 ng/mL）的患者正在接受监测，以观察隐匿性肝转移的出现。
