Background and study aim: The value of serum tumor markers carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) in the differential diagnosis of obstructive biliary disease is a matter of debate. We aimed to define their role prospectively.
Patients and methods: Thirty five cholestatic patients , 14 malignant group, their age ranged from 47-72 years (mean: 58.43 ± 9.08 years), 14 benign group, their age ranged from 46-72 years (mean: 60.21 ± 10.45 years) and 7 calcular, their age ranged from 48-71 years (mean: 60.14 ± 7.78 years) who were referred for endoscopic retrograde cholangiopancreatography examination for obstructive jaundice were included. Bile was obtained through cannulation of ERCP. Serum samples were taken from all patients at the time of acquisition of bile. Serum and bile samples were stored at -80 °C until they were tested. CEA and CA19-9 levels were measured with enzyme immunoassay methods in serum and bile samples by using Immunospec CA 19-9 and Immunospec CEA kits, respectively (Canoga Park,CA, 91303).
Results : In 14 patients with malignant disease, serum CEA levels were 36.77 (23.33-124.92) ng/ml and CA19-9 were 418.07 (1.23-483.47) U/ml, while in 14 patients with benign disease the serum CEA levels were 15.43 (0.38-30.80) ng/ml and CA19-9 were 144.6 (3.99-471.15) U/ml. The difference for both values was significant (p<0.05). In malignant disease bile CEA and CA19-9 levels were 5.05 (0-124.84) ng/ml, 455.61 (0.07-483.80) U/ml respectively, while in benign disease the corresponding levels were 3.22 (0-121.81) ng/ml for CEA and 421.45 (0-485.06) U/ml for CA19-9. The differences were not significant in this case (p>0.05).
Conclusion :It was concluded that serum CEA and CA19-9 levels are increased both in malignant and benign obstructive biliary diseases. However, levels of serum CEA are markedly increased and mostly restricted to malignant diseases. Measurement of these markers in bile was of no clinical significance.