[Fibronectin in human bile--a new parameter for diagnosis of malignant bile duct processes?--A pilot study]

In a pilot study it was investigated whether concentration of the glycoprotein fibronectin in the bile fluid can assist in differentiating between malignant and benign biliary tract obstructions. During endoscopic-retrograde cholangiography (ERC) and percutaneous transhepatic cholangiography (n = 3) native bile was aspirated in 29 patients. The concentration of fibronectin was determined by time resolved fluorescence immuno-assay. In 19 patients no biliary malignoma was present (choledocholithiasis: n = 9, normal finding: n = 10). Ten patients suffered from biliary or pancreatic cancer (infiltrating pancreatic cancer: n = 6; primary biliary tract cancer: n = 3, Klatskin tumor: n = 1). In the non malignant group a median fibronectin concentration of 12.0 ng/ml (lower-upper quartile 5-30 ng/ml) was found. A highly significantly elevated (p < 0.001, non parametric Kruskal-Wallis-test) median fibronectin concentration of 1675 ng/ml (lower-upper quartile 155-3430 ng/ml) could be determined in the malignant group. Our results show that in analogy to ascites, the concentration of biliary fibronectin is an important and easily determinable parameter in the differential diagnosis of benign und malignant diseases of the biliary tract.