肝外胆管癌术前影像学检查及CA19-9测定的诊断价值

目的:探讨影像学检查和糖链抗原(CA19-9)、癌胚抗原(CEA)测定对肝外胆管癌(extrahepatic cholangiocarcinoma,EHCC)的诊断价值. 方法:回顾性分析107例肝外胆管癌超声(US)、CT、磁共振胆胰管造影(MRCP)、内窥镜逆行胰胆管造影(ERCP)和经皮经肝胆道造影术(PTC)诊断结果,并与手术及病理结果对照. 其中,51例进行了血清CA19-9,CEA测定,22例进行了胆汁CA19-9,CEA的测定,并分别与胆道良性病变进行对照. 通过ROC曲线界定CA19-9,CEA对EHCC的诊断价值. 结果:肿块显示率US,CT,ERCP分别为70.8%,60.2%和69.0%;定位诊断准确率US,CT,MRCP, ERCP和PTC分别为72.9%,75.9%,100%,71.4%和76.9%;定性诊断准确率US,CT,MRCP,ERCP,PTC分别为70.8%,73.5%,86.2%,61.9%和58.3%. EHCC组与胆道良性病变组相比较,血清CA19-9,CEA浓度明显升高(P<0.01,P<0.05). 接收者工作特征(ROC)曲线显示,血清CA19-9,CEA和胆汁CA19-9的ROC曲线下面积(the area under the ROC curve, AUC)分别为0.942(P<0.001),0.516(P>0.05)和0.746(P<0.01);结果显示血清CA19-9和胆汁CA19-9对EHCC有较好的诊断价值. 血清CA19-9,CEA和胆汁CA19-9,CEA的敏感性分别为86%,26%,50%和32%,其特异性分别为88%,95%,94%和61%. 结论:MRCP对EHCC定位和定性诊断优于US,CT,ERCP及PTC,血清CA19-9的测定是EHCC术前可靠的定性诊断手段. EHCC的诊断步骤可归结为US结合临床资料进行初步筛选,US阳性者进行血清CA19-9测定,然后采用MRCP或CT进行定位诊断.

Preoperative diagnosis of extrahepatic cholangiocarcinoma: Application of CA19-9 and imaging

AIM: To explore the preoperative diagnostic value of different imaging methods, CA19-9 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 CA19-9 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 CA19-9 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 CA19-9 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 CA19-9, serum CEA, and bile CA19-9 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 CA19-9 were of better diagnostic value than serum CEA. The sensitivity of serum CA19-9, serum CEA, bile CA19-9 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 CA19-9 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 CA19-9 determination and MRCP or CT.