ABSTRACT
Introduction: There are, at present, no biomarkers topredict to prognosis of Gallbladder cancer. We conducted aprospective exploratory study to evaluate the role to serum CA19-9 and CA 242 as prognostic markers.Material and Methods: We enrolled consecutive patients forthis study and CA 19-9 and 242 were estimated from venoussamples. Association of these markers with clinical variablesand median overall survival (OS) difference between patientswho has raised versus normal levels of these markers wasdetermined.Results: Sixty-two patients were enrolled for this study.Forty-four (71%) patients had elevated CA19-9. Thirty-nine(62.9%) patients had an raised CA242 levels. CA 19-9 wasfound to be significantly associated with the presence ofjaundice (p=0.038) and advanced stage (p=0.009). MedianOS of patients who had elevated CA 19-9 was 5.73 monthscompared to 8.33 months in patients who had normal CA19-9. The difference was not statistically different (p= 0.15).Median OS for patients who had elevated CA 242 was 5.53months, which was inferior to those who had normal levels(9.1 months). This difference approached, but was notstatistically significant (p=0.055).Conclusion: This is the first study to show associationbetween CA 19-9 and stage of disease in GBC. At present,CA 19-9 and CA 242 cannot be recommended as prognosticmarkers. However, role of CA 242 needs to be examined ina larger cohort of patients of GBC to establish its usefulness.
ABSTRACT
Background & objectives: Biopsy of palpable breast masses can be performed manually by palpation guidance or under imaging guidance. Based on retrospective studies, image guided biopsy is considered more accurate than palpation guided breast biopsy; however, these techniques have not been compared prospectively. We conducted this prospective study to verify the superiority and determine the size of beneficial effect of image guided biopsy over palpation guided biopsy. Methods: Over a period of 18 months, 36 patients each with palpable breast masses were randomized into palpation guided and image guided breast biopsy arms. Ultrasound was used for image guidance in 33 patients and mammographic (stereotactic) guidance in three patients. All biopsies were performed using 14 gauge automated core biopsy needles. Inconclusive, suspicious or imaging-histologic discordant biopsies were repeated. Results: Malignancy was found in 30 of 36 women in palpation guided biopsy arm and 27 of 36 women in image guided biopsy arm. Palpation guided biopsy had sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 46.7, 100, 100, 27.3 per cent, respectively, for diagnosing breast cancer. Nineteen of 36 women (52.8%) required repeat biopsy because of inadequate samples (7 of 19), suspicious findings (2 of 19) or imaging-histologic discordance (10 of 19). On repeat biopsy, malignancy was found in all cases of imaging-histologic discordance. Image guided biopsy had 96.3 per cent sensitivity and 100 per cent specificity. There was no case of inadequate sample or imaging-histologic discordance with image guided biopsy. Interpretation & conclusions: Our results showed that in palpable breast masses, image guided biopsy was superior to palpation guided biopsy in terms of sensitivity, false negative rate and repeat biopsy rates.