Biliary carcinoembryonic antigen levels in diagnosis of occult hepatic metastases from colorectal carcinoma

AIM: To prospectively explore the role of carcinoembryonic antigen (CEA) in gallbladder bile in patients with colorectal carcinoma and the morphological and clinical features of neoplasia and the occurrence of hepatic metastases. METHODS: CEA levels in the gallbladder and peripheral blood were studied in 44 patients with colorectal carcinoma and 10 patients with uncomplicated cholelithiasis. CEA samples were collected from the gallbladder bile and peripheral blood during the operation, immediately before extirpating the colorectal neoplasia or cholecystectomy. Values of up to 5 ng/mL were considered normal for bile and serum CEA. RESULTS: In the 44 patients with colorectal carcinoma who underwent operation with curative intent, the average level of serum CEA was 8.5 ng/mL (range: 0.1 to 111.0 ng/ml) and for bile CEA it was 74.5 ng/mL (range: 0.2 to 571.0 ng/ml). In the patients with uncomplicated cholelithiasis who underwent cholecystectomy, the average level of serum CEA was 1.9 ng/mL (range: 1.0 to 3.5 ng/ml) and for bile CEA it was 1.2 ng/mL (range: 0.3 to 2.9 ng/ml). The average duration of follow-up time was 16.5 mo (range: 6 to 48 mo). Four patients who underwent extirpation of the colorectal carcinoma without evidence of hepatic metastasis and with an average bile CEA value of 213.2 ng/mL presented hepatic metastases between three and seventeen months after removal of the primary colorectal neoplasia. Three of them successfully underwent extirpation of the hepatic lesions. CONCLUSION: High CEA levels in gallbladders of patients undergoing curative operation for colorectal carcinoma may indicate the presence of hepatic metastases. Such patients must be followed up with special attention to the diagnosis of such lesions.