Bile levels of carcino-embryonic antigen in patients with hepatopancreatobiliary disease

Objective: To evaluate the value of biliary carcino-embryonic antigen (CEA) in the differential diagnosis of malignant and benign hepatopancreatobiliary disease. Patients: One hundred patients were prospectively studied. Benign diseases were present in 39% of the patients while 61% had malignant diseases. Methods: Samples of serum were taken from all patients just before endoscopic retrograde cholangiopancreatography (ERCP) and samples of biliary CEA were obtained during ERCP. Results: The sensitivities of serum CEA and carbohydrate antigen 19-9 (CA 19-9) in detecting malignancy were 50% and 92%, respectively, while the respective specificities were 95% and 72%. The mean biliary CEA level of the benign group was significantly different from that of the malignant group (35.7 +/- 8.7 ng/ml vs 268 +/- 85.5 ng/ml), but there was considerable overlap between the two groups. With a cut-off level of 20 ng/ml, the sensitivity and specificity were 84% and 64%, respectively. The mean bilirubinaemia value was significantly higher in malignant disease than in benign disease (57.4 +/- 13.9 mu mol/l vs 235 +/- 19.8 mu mol/l). Multidimensional analysis indicated that only bilirubinaemia (P<10(-3)) was independently predictive of malignant disease. Conclusion: Biliary CEA assessment seems useless in distinguishing between benign and malignant causes of cholestasis.