The assessment of biliary CA 125, CA 19-9 and CEA in diagnosing cholangiocarcinoma - The influence of sampling time and hepatolithiasis

Background/Aims: This study was conducted to assess the clinical value of biliary CA 19-9, CA 125 and CEA sampled in different situations for the diagnosis of cholangiocarcinoma. Methodology: Bile was obtained from patients with bile duct obstruction on the day of biliary drainage and 3 days later separately. The etiology of biliary obstruction included choledocholithiasis (N=51), hepatolithiasis (N=19) and cholangiocarcinoma (N=28). Patients of the former two conditions were all complicated with cholangitis. Results: The sensitivity of biliary CEA, CA 19-9 and CA 125, whenever checked were all less than 70%. The biliary CEA and CA 19-9 were elevated in the presence of cholangitis. In addition, the biliary CEA was also increased in the patients with hepatolithiasis. The specificity of CA 125 was better than those of CEA and CA 19-9 (75.7% vs. 33.3% and 60%, respectively) on the day of biliary drainage. The diagnostic efficiency was slightly improved when combining biliary CA 125 and CEA. Conclusions: As the biliary CA 125 was less affected by inflammation and hepatolithiasis, it is more useful than CEA and CA 19-9 in the diagnosis of cholangiocarcinoma. The single tumor marker test of CA 125 or combined tumor marker test of CEA and CA 125 may be used as a useful complement to other investigative methods to differentiate benign from malignant causes of the bile duct obstruction.