Abstract
Diagnosis of cholangiocarcinoma (CCA) is difficult when patients do not show jaundice. The aim of this study was to examine the feasibility of using the total serum bile acid (TSBA) level as an aid for the diagnosis of CCA in patients without jaundice. For this purpose, TSBA of the following groups were measured using a Beckman Synchron CX4 clinical chemistry analyzer: 60 cases of CCA with total serum bilirubin ≤2 mg/dL (low total bilirubin group, LTB); 32 cases of CCA with total serum bilirubin >2 mg/dL (high total bilirubin group, HTB); and 115 healthy controls. Liver function parameters such as serum cholesterol, albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were also examined. The results showed that the TSBA of both LTB and HTB groups of the CCA patients were significantly higher than that of the healthy controls. Also, significant correlation was observed between TSBA and total bilirubin levels in the HTB group of CCA patients. However, no such correlation was seen in the LTB group. The cut-off value of TSBA was determined for the LTB group of CCA patients using the receiver operating characteristic curve analysis, and it was 6.05 μmol/L with the sensitivity and specificity of 46.7% and 84.4%, respectively. In addition, the ALP level was correlated well with the TSBA level and ALP in HTB group was significantly higher than that of LTB group. Moreover, the combination of high TSBA and high ALP levels gave higher specificity up to 97.4%. TSBA might be useful for the diagnosis of CCA patients without jaundice.
Highlights
Cholangiocarcinoma (CCA) is a cancer of biliary epithelial cells
Significant correlation was observed between total serum bile acid (TSBA) and total bilirubin levels in the HTB group of CCA patients
The results showed that the TSBA level of CCA patients can be used as the diagnostic marker for CCA patients without jaundice, especially when it was combined with the serum alkaline phosphatase (ALP) level
Summary
The prevalence of CCA shows a wide geographic variability, with the highest rates in Asia, especially Southeast Asia (Blechacz and Gores, 2008). The incidence of intrahepatic CCA is highest in the Northeast Thailand, especially in Khon Kaen province (44.3/100,000 in men and 17.6/100,000 in women) (Wiangnon et al, 2012), because of the high prevalence of carcinogenic liver fluke, Opisthorchis viverrini, infection (Sripa et al, 2007; Sripa et al, 2011). CCA patients can be divided into two groups, those with obstructive jaundice and without jaundice, which can be distinguished by high and low levels of total bilirubin level in serum. Been focused on serum markers (Wongkham and Silsirivanit, 2012)
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