胰腺癌内镜超声引导下细针穿刺活检物中肿瘤标志物检测价值研究

Detection of tumor makers in biopsy from pancreatic adenocarcinoma obtained by EUS guided fine needle aspiration

目的 探讨检测内镜超声引导下细针穿刺（EUS—FNA）活检物中CEA、CA19-9常用肿瘤标志物对胰腺癌诊断的价值。方法2004年6月至2006年1月间的65例胰腺癌患者和25例慢性胰腺炎患者行EUS—FNA，采用电化学发光法对EUS—FNA活检物的离心上清进行CEA、CA19-9检测，并与该患者外周静脉血清中的CEA、CAl9-9进行对比和分析。随后对临床可疑胰腺癌而EUS—FNA病理学检测阴性的12例的病例进行随访，观察该方法诊断胰腺癌的敏感性。结果（1）胰腺癌患者中EUS—FNA标本中CEA和CAl9-9均高于血清（P〈0．01）。慢性胰腺炎患者EUS—FNA标本与血清中的CEA（P=0．122）和CAl9-9（P=0．035）都没有明显差别。（2）对于EUS—FNA标本，胰腺癌中的CEA、CAl9-9高于慢性胰腺炎（P〈0．01）。对于血清标本，慢性胰腺炎与胰腺癌中的CEA没有明显差别（P=0．079），胰腺癌中的CAl9-9高于慢性胰腺炎患者（P〈0．01）。（3）12例可疑胰腺癌随访后确诊10例为胰腺癌，2例为慢性胰腺炎。对于胰腺癌的诊断，血清CEA的敏感性为30％，血清CAl9-9为70％；EUS—FNA活检物中CEA和CAl9-9的预测敏感性均为90％。结论胰腺癌EUS—FNA活检物中的CEA、CAl9-9对提高胰腺癌诊断的敏感性具有较高的临床实用价值，为提高胰腺癌的诊断率提供了一种新的方法。

Objective To investigate whether determination of CEA and CA19-9 levels in EUS-FNA pancreatic samples can be useful in detecting pancreatic adenocareinoma and differentiating pancreatic adenocarcinoma from chronic pancreatitis, Methods Levels of CEA, CA19-9 were examined by chemiluminescence y analysis in EUS-FNA specimens obtained from 25 patients with chronic pancreatitis and 65 patients with pancreatic adenocareinoma, and compared with those of their peripheral serum. Twelve patients with suspected pancreatic adenocareinoma while with negative EUS-FNA pathological findings were fol- lowed up. Results First, the levels of CEA,CA19-9 in EUS-FNA specimens were higher than those in serum obtained from same patient with pancreatic adenocareinoma（ P 〈 0. 01 ）, but there was no difference in these variables of EUS-FNA specimens and serum obtained from patients with chronic pancreatitis . Second, in the EUS-FNA samples ,the levels of CEA,CA19-9 in pancreatic adenocareinoma were higher than those in chronic pancreatitis（P 〈0. 01 ）. On the contrary, in serum samples, there was no significant difference in CEA level between pancreatic adenocareinoma and chronic pancreatitis （P = 0. 079）. CA19-9 level in serum of pancreatic adenocareinoma was higher than that of chronic pancreatitis （ P 〈 0. 01 ）. Finally, during the follow-up, of all the 12 patients with suspected pancreatic adenocareinoma, 10 patients were diagnosed as having pancreatic adenocareinoma and 2 patients as having chronic pancreatitis . Diagnostic accuracy of serum CEA and CA19-9 were 30% and 70% respectively, while sensitivity of CEA and CA10-9 determined by EUS-FNA was both above 90%. Conclusion The method of measuring CEA and CA19-9 levels in samples obtained by EUS-FNA can be useful in detection of pancreatic adenocareinoma and differentiation of malignant pancreatic tissue from chronic pancreatitis.