the differential diagnosis cholangiocharcinoma and benign biliary tract disease can be difficult. Diagnostic evaluation such as hepatobiliary ultrasound, computed tomography, and angiography as well as brushings, and serum tumor markers are not
very
sensitive. The tumor marker carcinoembryonic antigen(CEA) has been identified by immunohistochemical analysis in bile duct tumors. The levels of carcinombryonic antigen(CEA) in the bile of 7 patients with biliary cancer, 9 patients with benign
biliary
stricture and 16 patients with cholelithiasis-choledocholithiasis were examined immunochemically by the Western blot analysis. CEA levels were determined using a solid phase, ABBOT CEA-EIA Monoclonal one step enzyme immunoasay. All samples of
bile
from
the patients with gallbladder-biliary cancer showed three bands that corresponded to CEA, non specific crossreacting antigen, and biliary glycorrotein 1, respectively. most of the bile from the patients with cholelithisis choledocholithiasis did
not
shew the upper band(CEA), even in thoses samples that had high level of CEA by the enzyme lmmunoassay.
The mean bile CEA level of 16 patient with cholelithiasis-choledocholithiasis was 51.84±41.67 ng/ml. The mean bile CEA level of 7 patients with biliary cancer(202.50±158.67 ng/ml) was significantly higher than that of the patients with
cholelithiasis-choledocholithiasis(P=0.002).
We suggest that, in order to diagnose the tumor, management of premalignant biliary disease such as sclerosing cholangitis, biliary cystic disease, not only should the level of bile CEA be measured but also a Western blot analysis of the bile
should be
performed since it is more reliable.
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