The clinical value of tumor markers in the differential diagnosis of pancreatic mass lesions

Objective To value the significance of the serum tumor markers carcinoembryonic antigen(CEA),CA199,and CA125 in the benign and malignant pancreatic diseases with and without obstructive jaundice.Methods The tumor markers CA199,CA125 and CEA in 60 patients with pancreatic neoplasm and 19 cases of patients with benign mass were detected.All the test of tumor markers and related reagents were used by chemiluminescent microparticle immunoassay(CMIA) to analyze the tumor markers in the differential diagnosis of pancreatic mass lesions.Results The diagnostic value of CA199 alone was the highest in differential diagnosis of pancreatic mass lesions.The sensitivity,specificity,the error rate and the missed diagnosis rate value of CA199 test were 66.7%,78.9%,22.1% and 33.3%,respectively(Youden index = 0.456).The sensitivity and specificity of a combined evaluation of both CA199 and CEA tests were 73.3% and 73.7%,respectively.The value of three combined tumor markers was not superior to the single CA199 asssy and the combined of CA199 and CEA assay,while increasing medical cost of patients.Although there was no significant difference between the CA199 positivity ratios of the jaundiced(33.3%) and non-jaundiced(18.8%) patient subgroups of the benign pancreatic diseases,this ratio was significantly higher in the jaundiced subgroup(78.9%) than the nonjaundiced subgroup(61.0%) of the pancreatic carcinoma(P 0.05).The CEA and CA125 positivity ratios of jaundiced and non-jaundiced subgroups of patients with benign and malignant pancreatic diseases were not significantly different.Conclusion These results suggest that the combined of CA199 and CEA,which could be improve the sensitivity and specificity(P 0.05),helaful to assess the pancreatic mass leisions.The blood jaundice level should be considered when using CA199 for the differential diagnosis of pancreatic neoplasm from benign pancreatic lesions;CA199 can be useful in the jaundiced patients,whereas CA125 and CEA provide a limited contribution in jaundiced patients.We can make a new set-point of CA199 for the diagnosis of pancreatic neoplasm by studying theROC curve and other statistic index to enhance the accuracy.