AI Article Synopsis

  • Differentiating malignant biliary diseases like cholangiocarcinoma (CCA) from benign conditions such as primary sclerosing cholangitis (PSC) using non-invasive blood markers is challenging, with several candidates like CA19-9, PKM2, and CYFRA21.1 showing promise.
  • A study tested these markers in 66 CCA and 62 PSC cases, finding that PKM2 was the best single marker at 61% sensitivity and 90% specificity, while a combined marker panel (PKM2, CYFRA21.1, MUC5AC, and GGT) improved sensitivity to 82%.
  • Some markers like LRG1 and IL6 were ineffective

Article Abstract

The non-invasive differentiation of malignant and benign biliary disease is a clinical challenge. Carbohydrate antigen 19-9 (CA19-9), leucine-rich α2-glycoprotein (LRG1), interleukin 6 (IL6), pyruvate kinase M2 (PKM2), cytokeratin 19 fragment (CYFRA21.1) and mucin 5AC (MUC5AC) have reported utility for differentiating cholangiocarcinoma (CCA) from benign biliary disease. Herein, serum levels of these markers were tested in 66 cases of CCA and 62 cases of primary sclerosing cholangitis (PSC) and compared with markers of liver function and inflammation. Markers panels were assessed for their ability to discriminate malignant and benign disease. Several of the markers were also assessed in pre-diagnosis biliary tract cancer (BTC) samples with performances evaluated at different times prior to diagnosis. We show that LRG1 and IL6 were unable to accurately distinguish CCA from PSC, whereas CA19-9, PKM2, CYFRA21.1 and MUC5AC were significantly elevated in malignancy. Area under the receiver operating characteristic curves for these individual markers ranged from 0.73-0.84, with the best single marker (PKM2) providing 61% sensitivity at 90% specificity. A panel combining PKM2, CYFRA21.1 and MUC5AC gave 76% sensitivity at 90% specificity, which increased to 82% sensitivity by adding gamma-glutamyltransferase (GGT). In the pre-diagnosis setting, LRG1, IL6 and PKM2 were poor predictors of BTC, whilst CA19-9 and C-reactive protein were elevated up to 2 years before diagnosis. In conclusion, LRG1, IL6 and PKM2 were not useful for early detection of BTC, whilst a model combining PKM2, CYFRA21.1, MUC5AC and GGT was beneficial in differentiating malignant from benign biliary disease, warranting validation in a prospective trial.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915126PMC
http://dx.doi.org/10.18632/oncotarget.24732DOI Listing

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