Nilubol Raunroadroong1,1, Hutcha Sriplung2,2, Nirush Lertprasertsuke3,3, Suwalee Pojchamarnwiputh4,4, Witthanee Na Chiangmai4,4, Worapon Sinsuwan1,1, Sumitra Thongprasert5,5. 1. Lampang Cancer Hospital, Lampang, Thailand. 2. Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand. 3. Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. 4. Department of Diagnostic Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. 5. Division of Medical Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Abstract
AIM: Cholangiocarcinoma (CCA) is a common form of cancer in Thailand. The diagnosis of CCA by pathology is widely accepted. Unfortunately, tissue diagnosis of mass-forming intrahepatic cholangiocarcinoma is difficult to perform due to the risk of the procedure and accessibility. The aim of this study is to assess the diagnostic utility of CA19-9 in combination with CT scan for the diagnosis of mass-forming cholangiocarcinoma. MATERIALS & METHODS: The medical records of patients with a diagnosis of CCA and hepatocellular carcinoma (HCC) during January 2005-December 2009 were reviewed. Only cases with pathology and CT scan reports from Maharaj Nakorn Chiang Mai Hospital were included. Demographic data, clinical manifestations and laboratory results, including CA19-9 and CT scans of the liver, were carefully examined in order to establish their diagnostic utility in mass-forming CCA without a pathological diagnosis. RESULTS: A total of 79 CCA patients and 66 HCC patients were included in CA19-9 cut-off level analyses. A total of 31 CCA patients and 44 HCC patients were included in the CT scan evaluation and scored according to the Chiang Mai CT score for CCA. The specificity of a CA19-9 value of 500 U/ml for the diagnosis of CCA was 95.5% with a sensitivity of 50.6%, positive predictive value of 91.8% and likelihood ratio of positive (LR+) of 11.24. A CT score greater than 2 demonstrates a positive predictive value of more than 90% in diagnosis of CCA. The CA19-9 level of 140 U/ml in combination with a CT score of 2 demonstrated LR+ as high as 57.09. A CA19-9 level of 280 U/ml in combination with a CT score of 1 demonstrated LR+ of 58.4. CONCLUSION: A CA19-9 level combined with the Chiang Mai CT score for CCA are good diagnostic tools for the diagnosis of mass-forming cholangiocarcinoma with high specificity, high positive predictive value and high likelihood ratio of positive.
AIM: Cholangiocarcinoma (CCA) is a common form of cancer in Thailand. The diagnosis of CCA by pathology is widely accepted. Unfortunately, tissue diagnosis of mass-forming intrahepatic cholangiocarcinoma is difficult to perform due to the risk of the procedure and accessibility. The aim of this study is to assess the diagnostic utility of CA19-9 in combination with CT scan for the diagnosis of mass-forming cholangiocarcinoma. MATERIALS & METHODS: The medical records of patients with a diagnosis of CCA and hepatocellular carcinoma (HCC) during January 2005-December 2009 were reviewed. Only cases with pathology and CT scan reports from Maharaj Nakorn Chiang Mai Hospital were included. Demographic data, clinical manifestations and laboratory results, including CA19-9 and CT scans of the liver, were carefully examined in order to establish their diagnostic utility in mass-forming CCA without a pathological diagnosis. RESULTS: A total of 79 CCA patients and 66 HCC patients were included in CA19-9 cut-off level analyses. A total of 31 CCA patients and 44 HCC patients were included in the CT scan evaluation and scored according to the Chiang Mai CT score for CCA. The specificity of a CA19-9 value of 500 U/ml for the diagnosis of CCA was 95.5% with a sensitivity of 50.6%, positive predictive value of 91.8% and likelihood ratio of positive (LR+) of 11.24. A CT score greater than 2 demonstrates a positive predictive value of more than 90% in diagnosis of CCA. The CA19-9 level of 140 U/ml in combination with a CT score of 2 demonstrated LR+ as high as 57.09. A CA19-9 level of 280 U/ml in combination with a CT score of 1 demonstrated LR+ of 58.4. CONCLUSION: A CA19-9 level combined with the Chiang Mai CT score for CCA are good diagnostic tools for the diagnosis of mass-forming cholangiocarcinoma with high specificity, high positive predictive value and high likelihood ratio of positive.
Entities:
Keywords:
CA19-9 level; CT scan; Chiang Mai CT score for CCA; cholangiocarcinoma