Clinical Evaluation of Tumour Marker Combinations in the Differential Diagnosis of Benign and Malignant Liver Disease

M E Lucarotti,R C N Williamson,S B Kelly,M J Hershman,N D Rothnie,C B Wood,O Nilsson,L Lindholm,C Johanssen,N A Habib

doi:10.1155/1991/23874

Abstract

CEA, CA19-9 and CA50 are tumour associated antigens defined by monoclonal antibodies which have been raised against adenocarcinoma cell lines. The aim of this study was to determine whether their combined use could improve diagnostic accuracy in patients with primary and secondary liver tumours. An immunoradiometric assay was used for the detection of CEA and CA19-9 and the Delfia system for CA50. Serum was collected from 65 normal subjects, 40 with hepatobiliary carcinoma (26 primary, 14 secondary) and 17 with benign hepatobiliary disease. The cut-off levels were calculated as the mean of the control group plus 2 standard deviations. All three antibodies contributed to improving the correct classification of secondary liver tumours (multivariant discriminant analysis p<0.05), but only CA19-9 and CA50 contributed to the diagnosis of primary liver tumours (multivariant analysis p<0.05). The diagnostic accuracy versus benign disease was 81% for primary carcinoma and 91% for secondary carcinoma. Combined use of CEA, CA19-9 and CA50 helps to differentiate benign from malignant hepatobiliary disease.

Highlights

In the last three decades hepatobiliary surgery has progressed to become a distinct sub-speciality, with a mortality rate for hepatic resection below 5% 1’2
Hepatectomy may be suitable for primary malignant tumours, but in the western world these are outnumbered by liver metastases, 70% of which originate from colorectal primary lesions[3]
The analysis showed a positive result with 53% of the whole malignant group, none of the benign group and 8% of the control group

Summary

Introduction

In the last three decades hepatobiliary surgery has progressed to become a distinct sub-speciality, with a mortality rate for hepatic resection below 5% 1’2. Hepatectomy may be suitable for primary malignant tumours (hepatocellular carcinoma, cholangiocarcinoma), but in the western world these are outnumbered by liver metastases, 70% of which originate from colorectal primary lesions[3]. Since most patients with colorectal secondaries are asymptomatic at first, a sensitive test is required to diagnose them early enough for surgical treatment still to be feasible;. Determination of high levels of carcino-embryonic antigen (CEA) in the serum is one such possibility[4]. At present resection of colorectal liver metases is only possible in 30-40% of patients, 5’6 but up to 25% of these may be expected to survive 5 years. Address correspondence to: Miss M.E. Lucarotti, University Department of Surgery, Bristol Royal

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Conclusion