Background/Aim: Despite the presence of many diagnostic methods, the differential diagnosis between benign and malignant biliary obstructions is still not easy. We aimed to study the diagnostic value of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and carbohydrate antigen 125 (CA125) in serum and in bile by ERCP for discrimination between benign and malignant pancreatobiliary diseases.
Methods: Between November 2016 to April 2018, fifty patients with biliary obstruction, were included in the study. Twenty five malignant group with a median age 62.68±10.246 years, 25 benign group with a median age 47.52±13.793 years who were referred for ERCP 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, CA19-9 and CA 125 levels were measured with enzyme-linked immune-sorbent assay (ELISA) using CEA, CA19-9 and CA-125 ELISA kits (Immunospec Corporation,Canoga Park, CA, USA), the reference numbers for the kits are E29-207, E29-210 and E29-208 respectively.
Results: The benign group consisted of 15 men, 10 women with a median age 47.52±13.793 years while the malignant group consisted of 14 men, 11 women with a median age 62.68±10.246 years. In 25 patients with malignant obstrucion, serum CEA levels were 98.160 ng/ml, CA19-9 were 331.28 U/ml and serum CA 125 were 272.88 while in 25 patients with benign disease the serum CEA levels were 40.688 ng/ml, CA19-9 were 125.20 U/ml and CA 125 were 78.16 U/ml. The difference for both values was significant (p= 0.000). In malignant disease bile CEA, CA19-9, CA 125 levels were 109.040 ng/ml, 244.60 U/ml and 176.16 U/ml respectively, while in benign disease the corresponding levels were 2.824 ng/ml for CEA, 28.52 U/ml for CA19-9 and 28.80 U/ml for CA125 . The differences were significant in this case (p= 0.000)
Conclusion: Serum CA19-9, CEA and CA 125 levels are increased in malignant obstructive biliary diseases, likewise, the biliary markers showed uprise in malignant diseases. Accordingly, Serum and bile tumor markers, when studied alone, lack the diagnostic concern to discriminate benign from malignant pancreatobiliary diseases. In cases of diagnostic dilemmas the combination of serum and bile markers might be of value.