肝外胆管癌术前影像学检查及CA19-9测定的诊断价值  

Preoperative diagnosis of extrahepatic cholangiocarcinoma: Application of CA19-9 and imaging

作　　者：秦兴雷[1] 王作仁[1] 强永乾[2] 韦晓峰[3] 张毅力[2] 张云锋[1] 马炜[1] 

机构地区：[1]西安交通大学第一医院肝胆外科,陕西西安710061 [2]西安交通大学第一医院影像中心,陕西西安710061 [3]洛阳市中心医院影像中心,河南洛阳471009

出　　处：《第四军医大学学报》2005年第1期45-49,共5页Journal of the Fourth Military Medical University

摘　　要：目的 :探讨影像学检查和糖链抗原 (CA19 9)、癌胚抗原 (CEA)测定对肝外胆管癌 (extrahepaticcholangiocarcinoma,E HCC)的诊断价值 .方法 :回顾性分析 10 7例肝外胆管癌超声(US)、CT、磁共振胆胰管造影 (MRCP)、内窥镜逆行胰胆管造影(ERCP)和经皮经肝胆道造影术 (PTC)诊断结果 ,并与手术及病理结果对照 .其中 ,5 1例进行了血清CA19 9,CEA测定 ,2 2例进行了胆汁CA19 9,CEA的测定 ,并分别与胆道良性病变进行对照 .通过ROC曲线界定CA19 9,CEA对EHCC的诊断价值 .结果 :肿块显示率US,CT ,ERCP分别为 70 .8% ,6 0 .2 %和6 9.0 % ;定位诊断准确率US ,CT ,MRCP ,ERCP和PTC分别为72 .9% ,75 .9% ,10 0 % ,71.4 %和 76 .9% ;定性诊断准确率US ,CT ,MRCP ,ERCP ,PTC分别为 70 .8% ,73.5 % ,86 .2 % ,6 1.9%和5 8.3% .EHCC组与胆道良性病变组相比较 ,血清CA19 9,CEA浓度明显升高 (P <0 .0 1,P <0 .0 5 ) .接收者工作特征 (ROC)曲线显示 ,血清CA19 9,CEA和胆汁CA19 9的ROC曲线下面积 (theareaundertheROCcurve ,AUC)分别为 0 .94 2 (P <0 .0 0 1) ,0 .5 16 (P >0 .0 5 )和 0 .74 6 (P <0 .0 1) ;结果显示血清CA19 9和胆汁CA19 9对EHCC有较好的诊断价值 .血清CA19 9,CEA和胆汁CA19 9,CEA的敏感性分别为 86 % ,2 6 % 。AIM: To explore the preoperative diagnostic value of different imaging methods, CA19-9 determination and CEA determination in diagnosing extrahepatic cholangiocarcinoma (EHCC). METHODS: The diagnostic efficacy of various imaging methods was analyzed retrospectively in 107 patients with EHCC. We measured CA19-9 and CEA concentrations of serum and bile in patients with EHCC (n= 51) and benign biliary diseases (n=42). A receiver operation characteristic (ROC) curve was used to define a new strategy for interpreting CA19-9 and CEA in EHCC. RESULTS: The preoperative diagnostic accuracy rates of tumor visualization of ultrasonography (US), computed tomography (CT) and magnetic resonance imaging cholangiopancreatography (MRCP) in diagnosing EHCC were 70.8% , 60.2% and 69.0%, respectively. The diagnostic accuracy rates of tumor location of US, CT, MRCP, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) in diagnosing EHCC were 72.9%, 75.9%, 100%, 71.4% and 76.9% , and the diagnostic accuracy rates for tumor quality were 70.8%, 73.5%, 86.2%, 61.9% and 58.3%, respectively. The serum CA19-9 and serum CEA concentrations significantly elevated (P<0.01 and P<0.05) in patients with EHCC compared with those in patients with benign biliary diseases. The ROC curves analysis showed that the area under the ROC curve(AUC)of serum CA19-9, serum CEA, and bile CA19-9 were 0.942 (P<0.001), 0.516 (P>0.05) and 0.746 (P<0.01), respectively. The outcome showed that the serum and bile CA19-9 were of better diagnostic value than serum CEA. The sensitivity of serum CA19-9, serum CEA, bile CA19-9 and bile CEA in diagnosing EHCC were respectively 86%, 26%, 50% and 32%, and the corresponding specificity when compared with those of the benign biliary disease group were 88%, 95%, 94% and 61%, respectively. CONCLUSION: MRCP is superior to US, CT, ERCP and PTC in locating the position and the nature of the tumor. The determination of serum CA19-9 is a reliable test for the differential

关 键 词：胆管肿瘤 肝外胆管 诊断显像 肿瘤标记物 糖链抗原19-9 诊断 

分 类 号：R657.4[医药卫生—外科学]