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%. 76Selenomethionine 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 (greater than 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, 75Se-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.

Alpha fetoprotein-producing acinar cell carcinoma of the pancreas showing multiple lines of differentiation

“…ACCs have been reported to account for 1% of exocrine pancreatic malignant tumours [2,18]. The incidence of pancreatic tumours with elevated AFP level ranges widely from 6% [4] to 24% [17] clinically, but AFP-producing ACCs confirmed immunohistochemically are few, comprising only 4.5 [8] and 6% [14] in two recent ACC series. Markedly elevated serum AFP levels were detected in five tumours in other published series [13, 20, 23].…”

Intra- and postoperative radiation therapy for an alpha-fetoprotein-producing pancreatic carcinoma

“…Generally speaking, the markers of pancreatic tumors are CEA10 and CA 19–9 11. High serum AFP levels are rarely observed in patients with pancreatic cancer.…”

“…High serum AFP levels are rarely observed in patients with pancreatic cancer. According to several workers, the incidence of high serum AFP levels in such patients has been reported to be 2.1%‐24.0% 10,. Most of the AFP‐producing pancreatic cancers that have been reported were acinar cell carcinomas or pancreatoblastomas .…”

“…According to several workers, the incidence of high serum AFP levels in such patients has been reported to be 2.1%-24.0%. 10,[12][13][14][15][16] Most of the AFP-producing pancreatic cancers that have been reported were acinar cell carcinomas or pancreatoblastomas. [3][4][5][6][7][8][9] Tanno et al reported a case of an AFP-producing mucin-producing carcinoma of the pancreas.…”

The detection and evaluation of human tumor metastases

“…The group who proved to have no evidence of malignant disease had CEA levels greater than the limit of 63o/o of cases. At a 5 ng/ml level the false positive rate fell to 11%, but the group with cancer exceeded this limit in only 57% of cases (151). In a trial with the direct assay, CEA levels played little part in establishing a diagnosis of pancreatic cancer (152).…”