The Value of Diagnostic Aids in Detecting Pancreas Cancer

Abstract

By contract with the National Cancer Institute, the accuracy of diagnostic techniques was assessed in 184 patients suspected of having pancreas cancer. Of 138 patients who were operated upon, 89 were found to have pancreas duct cancer, 30 had cancer of a different site of origin in the head of the pancreas region and in 19 there was no evidence of cancer at operation. All of the 46 patients who were not operated upon, 13 proven to have cancer and 33 patients discharged as free of cancer, were followed in our clinic. The majority of our patients presented with signs and symptoms of biliary obstruction. Computerized transaxial tomography (CTT) gave a "correct" diagnosis in 31 of 33 patients (94%) with proven cancer, there were 2 patients with a false negative report and a false positive diagnosis occurred in 8 of 20 patients (40%) without cancer. Celiac angiography (CA) gave a correct diagnosis in 78 of 94 patients (83%) with cancer, a false negative in 17%, and a false positive in 32%. "Selenomethionine pancreas scan correctly diagnosed 27 of 36 patients (75%) with cancer, gave a false negative in 25% and a false positive in 31%. Ultrasonography gave a correct diagnosis in 18 of 27 patients with cancer (67%), a false negative in 33% and a false positive in 28%. Endoscopic retrograde cholangiopancreatography diagnosed correctly 8 of 11 cases (73%) of cancer, there were false negative diagnoses in 3 cases (27%) and false positives in 3 of 14 patients (21%). Duodenal aspiration techniques gave a very low percentage of correct diagnoses. Chronic pancreatitis most commonly gave rise to a false positive diagnosis. Serum alkaline phosphatase was elevated in 82% of patients, gave 18% false negatives and 33% false positives. Carcinoembryonic antigen (CEA) was elevated (> 2.5 ng/ml) in most of the pancreas cancer patients but also in patients with other cancers and with non-cancerous diseases. In our hands, CTT, CA, alkaline phosphatase, "Se-methionine and ultrasonography, in descending order, have given the highest percentage of correct diagnoses but false positive and false negative diagnoses prevented any single test from being conclusive.CUMH 41~868-879,1978. ANCREAS CANCER, THE FOURTH MOST COMMONyears, but also because there does not appear to P human cancer, is one of the most disheart-be an improvement over a 20 year span from ening of malignant neoplasms, not only because 1940 to 1969 in the percentage of cancers discovof its survival rate of only a few percent for 5 ered localized to the gland.',',' For that reason From Memorial Hospital, Memorial Sloan-Kettering

The Value of Routine Biochemical Tests in Discriminating Between Malignant and Benign Pancreatic Tumours

“…Amylase was within the limits of the normal range in most of the patients in the present study which is in accordance with the results presented by Fitzgerald 9 who found elevated amylase activity in the serum of only 14% of patients with pancreatic cancer, in 31% of patients with other gastrointestinal cancers and in 9% of patients with chronic pancreatitis. Thus amylase seems of merit only in the diagnosis of acute pancreatitis16.…”

Combined Determination of Serum CA 19-9 and Tissue Polypeptide Antigen: Why No Improvement in Pancreatic Cancer Diagnosis

“…A num ber o f serum m arkers have been proposed for the detection of pancreatic cancer [1][2][3]; among them CA 19-9 and tissue polypeptide antigen (TPA) seem to be the most promising. CA 19-9 is a recently identified tum or m arker especially useful in detecting pancreatic malignancy.…”

“…CA 19-9 is a recently identified tum or m arker especially useful in detecting pancreatic malignancy. It presents a satisfactory sen sitivity and specificity in the differential diagnosis of pancreatic cancer and the other gastrointestinal dis eases [4][5][6][7][8][9][10][11][12][13][14][15], TPA has been suggested as having a good 1 Partially supported by a grant of the Italian National Research Council, Special Project ' contract No. 86.00521.44.…”

“…This study was undertaken in order: (1) to compare the usefulness o f CA 19-9 and TPA in diagnosing pancreatic cancer; (2) to verify whether the combined assessment of the two indices could improve the re sults given by CA 19-9 or TPA alone; and (3) to speculate on the role of liver dysfunction in increasing serum levels of both markers.…”

SALL4 is expressed in pancreatic acinar cell carcinoma

“…Clinically, the incidence of pancreatic tumors with elevated AFP level ranges from 6% to 24% [26,27] while immunehistochemically-confirmed cases comprise 4.5% to 6% [1,2] . AFP is produced in the liver, yolk sac, and in the fetal gastrointestinal tract [28] .…”