Forty gastric adenocarcinomas in 30 resected stomachs were examined by an endoscopic immunofluorescent technique using fluorescein isothiocyanate (FITC)-labeled antibodies to carcinoembryonic antigen (CEA). Fluorescence images of the tumors were obtained with a newly developed endoscopic television system for detecting faint fluorescence. Computer-assisted processing was used to enhance the detection and localization of the tumors visualized by the immunofluorescent technique. Twenty seven (90%) of 30 tumors showed positive fluorescence after treatment with FITC-labeled antibodies for 60 minutes, whereas only two (40%) of five cancers could be detected by the immunofluorescent technique after treatment with antibodies for less than 60 minutes. There was no significant relationship between positive fluorescence and the gross and histological types or the stages of the tumors. In contrast, no positive fluorescence could be demonstrated in cases of benign gastric lesions or after pretreatment with FITC-labeled alpha-fetoprotein. This study therefore suggests that the immunofluorescent technique using FITC-labeled anti-CEA antibodies can be useful in detecting the early stages of gastric cancer.
SUMMARY Carcinoembryonic antigen (CEA) and elastase 1 in the serum were determined by enzyme immunoassay and radioimmunoassay, respectively, in 224 healthy subjects, 49 patients with pancreatitis, 53 patients with pancreatic carcinoma and 129 patients with cancer in other organs. The CEA concentrations in the serum were significantly higher in patients with pancreatic carcinoma than in those with pancreatitis, but this concentration was not a satisfactory indicator of pancreatic carcinoma localised to allow irradication by resection as it was raised in only 47% of the patients. High CEA concentrations were also slightly, but not significantly, more frequent in patients with cancer of the pancreatic body or tail, and unresectable cancer or cancer of more than 6.0 cm in longest diameter than in those with cancer of the pancreatic head, resectable cancer or cancer of less than 6-0 cm diameter. Serum elastase 1 was raised in only 42% of the patients with pancreatic carcinoma and could not be used to distinguish patients with pancreatic carcinoma from those with pancreatitis. In contrast with CEA, however, its concentration was abnormally high significantly more frequently in patients with cancer of less than-6.0 cm in longest diameter than in those with larger tumours. It was also raised slightly, but not significantly, more frequently in those with cancer of the pancreatic head and in patients with resectable cancer than in those with unresectable cancer. A combination of these two tests raised the diagnostic rate of pancreatic carcinoma to 77% without a remarkable decrease in the specificity for pancreatic carcinoma. In particular, it raised the diagnostic rates of cases of cancer of the pancreatic head, resectable cancer and cancers of less than 3.0 cm and 3.0-6.0 cm in longest diameter. Therefore, a combination of measurements of CEA and elastase 1 in the serum is very useful for early detection of pancreatic carcinoma.
The levels of carcinoembryonic antigen (CEA), elastase 1, and carbohydrate antigen determinant (CA 19-9) in the pancreatic cystic fluid and the serum from five patients with cystadenocarcinoma of the pancreas, one patient with retention cyst due to pancreatic carcinoma, three patients with cystadenoma, and eight patients with benign pseudocyst accompanying or following pancreatitis, were determined by immunoassay technique. Fluid from pancreatic cysts was obtained by ultrasonically-guided percutaneous fine-needle aspiration biopsy. The specimens were centrifuged and the supernatant was used for the measurement of CEA, elastase 1, and CA 19-9, while the cell pellet was examined cytologically. The levels of CEA in the aspirated fluid were significantly higher in patients with malignant cysts of the pancreas than in those with benign cystadenomas and pseudocysts. In contrast, the levels of elastase 1 were significantly lower in patients with malignant cysts than in those with benign pancreatic cysts. Although the levels of CA 19-9 were significantly higher in patients with malignant cysts than in those with pseudocysts, the overlap between the values of patients with malignant and benign pancreatic cysts is too great. The serum CA 19-9 was most useful, however, to distinguish an individual patient with malignant cysts of the pancreas from those with benign pancreatic cyst, since there were no significant differences between the levels of serum CEA and elastase 1 in patients with malignant and benign pancreatic cysts. Correct diagnoses were made cytologically in 4 (66.7%) of 6 patients with malignant cysts. In two patients with malignant cyst, in whom no cancer cells were detectable in the aspirated materials, levels of CEA were abnormally high, but high levels of elastase 1 did not occur. Therefore, the combined measurement of CEA and elastase 1 in the aspirated cystic fluid of the pancreas could be used as an aid in diagnosis of malignant cysts of the pancreas.
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