The Diagnostic Worth of Serum CA19-9 and CEA Levels in Anicteric Patients with Thick Walled Gallbladder
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2018, Vol 3, Issue 7
Abstract
Introduction: Gallbladder carcinoma (GBC) is the most common malignancy of the biliary tract, accounting for 80–95% of biliary tract cancers.1 GBC affects over 140 000 patients worldwide and over100 000 die each year from this aggressive disease.2 The value of CEA (carcinoembryonic antigen) and/or CA19-9 (Carbohydrate antigen) in the prognosis of gallbladder cancer has been previously reported.4, 8 However, their role in evaluation of thick walled gall bladder where, GBC is a suspect, is still largely wanting. We decided to audit our records, in order to address this issue of finding the significance of CA19-9 and CEA, as diagnostic marker in patients with thick walled gall bladder with a high index of suspicion of GBC, the lesion being resectable on imaging. Method: A cross sectional analysis of 48 anicteric patients with thick walled gall bladder was done from January 2017 to January 2018. Tumour markers viz. CA19-9, CEA were recorded preoperatively along with other patient characteristics and then correlated with the final histopathological diagnosis. Statistical analysis was done using SPSS VERSION 21. Results: 48 patients of anicteric thick walled gall bladder (on imaging) were taken up for surgery. Mean age in this study was 53 years. Male: Female ratio was 11:37. There were 15 patients of gall bladder cancer while the other 33 turned out to have a benign pathology on final biopsy (6 Xanthogranulomatous cholecystitis and 27 cases of chronic cholecystitis). Presence of regional lymphadenopathy (p<0.001) and suspicion of abdominal metastasis (p=0.008) were found to have statistical association with presence of cancer and with CA19-9 level above 35U/ml. CEA level>5ng/ml, was found in only 4(8.3%) patients, 3(6.2%) of these patients had cancer while 1(2.1%) had an inflammatory gall bladder (p=0.049), the value just attaining significant association with the presence of cancer. On multivariate analysis no independent predictor could be identified. The sensitivity and specificity of preoperative CA19-9 was 24.24% and 22.22% in predicting cancer in this study while CEA failed to demonstrate any predictive significance. Conclusion: In anicteric patients with thick walled gallbladder and suspicion of gallbladder malignancy, Serum CA19-9 and CEA levels alone have low predictive significance. Their role as tumour marker however increases in the presence of CECT findings of regional lymphadenopathy, locally advanced or metastatic disease.
Authors and Affiliations
Dr. Shakeel Masood
Keywords
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