Diagnosis Of Pancreatic Carcinoma Research Articles

Carbohydrate antigen 19-9 for differential diagnosis of pancreatic carcinoma and chronic pancreatitis.

To evaluate the utility of carbohydrate antigen 19-9 (CA19-9) for differential diagnosis of pancreatic carcinoma and chronic pancreatitis. We searched the literature for studies reporting the sensitivity, specificity, and other accuracy measures of serum CA19-9 levels for differentiating pancreatic carcinoma and chronic pancreatitis. Pooled analysis was performed using random-effects models, and receiver operating characteristic (ROC) curves were generated. Study quality was assessed using Standards for Reporting Diagnostic Accuracy and Quality Assessment for Studies of Diagnostic Accuracy tools. A total of 34 studies involving 3125 patients with pancreatic carcinoma and 2061 patients with chronic pancreatitis were included. Pooled analysis of the ability of CA19-9 level to differentiate pancreatic carcinoma and chronic pancreatitis showed the following effect estimates: sensitivity, 0.81 (95%CI: 0.80-0.83); specificity, 0.81 (95%CI: 0.79-0.82); positive likelihood ratio, 4.08 (95%CI: 3.39-4.91); negative likelihood ratio, 0.24 (95%CI: 0.21-0.28); and diagnostic odds ratio, 19.31 (95%CI: 14.40-25.90). The area under the ROC curve was 0.88. No significant publication bias was detected. Elevated CA19-9 by itself is insufficient for differentiating pancreatic carcinoma and chronic pancreatitis, however, it increases suspicion of pancreatic carcinoma and may complement other clinical findings to improve diagnostic accuracy.

CA19-9 and CK immunohistochemical expression in pancreatic and ampulla of vater carcinomas (A clinicopathological study

Background: Pancreatic carcinoma is one the most lethal malignancies and the Prognosis for patients with locally advanced or metastatic disease is poor. The 5-year survival rate is about 4%, which is the lowest of any cancer and median survival is 6 months. The high mortality rate is largely due to the typically advanced stage of the cancer at the time of diagnosis and treatment. Resection is the only current treatment resulting in cure for pancreatic carcinoma. However, due to the initiation and progression of this cancer without symptoms, only about 10% to 15% of patients present with localized disease amenable to potentially curative resection. Chemotherapy increases survival and up to date, the use of palliative chemotherapy is increasing due to the availability of more drugs and a wider range of indications. CA 19–9 is the marker most widely used clinically as elevated in approximately 75% of patients with pancreatic carcinoma with reported sensitivities ranging from 70% to 90% and specificities ranging from 68% to 91% with great support of CK marker in excluding or confirm diagnosis.
 Objectives: Evaluation of CA19-9 and CK HMW markers expression in pancreatic and ampulla of vater carcinoma immunohistochemically & to correlate the immunohistochemical expression of CA19-9 and CK HMW markers with carcinoma location.
 Material and method:- 36 samples of whipple operations and partial pancreatectomy whom already diagnosed as pancreatic carcinoma from 2009-2013 whom visit and admitted to GIT hospital in Baghdad medical city. A tissue sample block from mass that already processed and identified by dissection report from data base of histopathology Lab was collected for staining by immunohistochemical method with C19.9 and CK marker.
 Results:-36 patients - 24 male and 12 females, Mean age (45+2.02) range (28-65) year with Male: Female ratio is (2:1) As differentiation of malignant cell in this study it was higher level with grade II (60%) For TNM classification the result was dominantly staging as T3. IHC staining of CK19-9:-in present study we have 75% of patient samples with positive result. .Present study show that 4 patient's samples of total 6 positive CK/IHC staining was pancreatic carcinoma while only 2 of total positive was ampulla carcinoma. 
 Conclusion:-CA19-9 is pancreatic tumor associated marker but cannot used for screening and association with clinical findings. Meanwhile CK tissue immunolabling mostly helpful in diagnosis of ampullary and pancreatic carcinoma and CK immunohistochemical staining can be used as exclusion aid in diagnosis of pancreaticcarcinoma.

Multiprobe FISH on Pancreatic Adenocarcinoma Diagnosed by EUS-FNA of the Pancreas: A Validation Study

Introduction: Cautious approach to pancreatic FNA often results in an indeterminate diagnosis on pancreatic endoscopic ultrasound guided (EUS) fine needle aspiration. Utilization of ancillary studies may help confirm a diagnosis of carcinoma of the pancreas. This has a distinct potential to help patients and clinical teams arrive at early informed patient management decisions. Recent recommendations on utilization of ancillary studies in pancreatobiliary tree analysis suggested a possible role for fluorescence in situ hybridization (FISH) studies as an adjunct to cytology for pancreatic masses (Diagn. Cytopathol. 2014; 42:351e362). Our objective for the study was to determine performance characteristics of commercially available multiprobe FISH (CEP3, CEP7, CEP17 and locus specific probe for chromosome 9p21) on EUS-FNA of the pancreas. Materials and Methods:We prospectively collected EUS-FNA samples for UroVysion (Abbott Inc) multiprobe FISH analysis. Residual FNA sample after the diagnosis was forwarded for FISH analysis in preservecyt. Sample preparation and analysis were performed as per the manufactures’ suggested protocol. A statistical analysis using a two tailed student t test was performed. Results: We analyzed 32 samples from 30 patients. The mean age was 67 yrs (range: 42-90 yrs). The tumor size ranged from 1.1 e 7 cms (mean 3.0 cms). Eighteen of the 19 (95%) adenocarcinoma were positive for UroVysion FISH. Of the 2 cases deemed negative by cytology both were considered UroVysion negative. Aneusomy was statistically significantly associated with adenocarcinoma (pZ 0.014). Of the 8 indeterminate cases 4 cases each were considered as either atypical or suspicious for adenocarcinoma. Lack of cellularity precluded adequate analysis by FISH in suspicious (nZ 3) and atypical (nZ3) cases. One of 4 (25%) cases suspicious for carcinoma was positive by FISH. Conclusion: Aneusomy on UroVysion FISH can be used as an ancillary tool to support a diagnosis of pancreatic carcinoma on EUS-FNA samples.

Diagnosis of pancreatic carcinoma based on combined measurement of multiple serum tumor markers using artificial neural network analysis

Background Artificial neural network (ANN) has demonstrated the ability to assimilate information from multiple sources to enable the detection of subtle and complex patterns. In this research, we evaluated an ANN model in the diagnosis of pancreatic cancer using multiple serum markers. Methods In this retrospective analysis, 913 serum specimens collected at the Department of General Surgery of Beijing Friendship Hospital were analyzed for carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 125 (CA125), and carcinoembryonic antigen (CEA). The three tumor marker values were used as inputs into an ANN and randomized into a training set of 658 (70.31% were malignant) and a test set of the remaining 255 samples (70.69% were malignant). The samples were also evaluated using a Logistic regression (LR) model. Results The ANN-derived composite index was superior to each of the serum tumor markers alone and the Logistic regression model. The areas under receiver operating characteristic curves (AUROC) was 0.905 (95% confidence Interval (CI) 0.868-0.942) for ANN, 0.812 (95% CI 0.762-0.863) for the Logistic regression model, 0.845 (95% CI 0.798-0.893) for CA19-9, 0.795 (95% CI 0.738-0.851) for CA125, and 0.800 (95% CI 0.746-0.854) for CEA. ANN analysis of multiple markers yielded a high level of diagnostic accuracy (83.53%) compared to LR (74.90%). Conclusion The performance of ANN model in the diagnosis of pancreatic cancer is better than the single tumor marker and LR model.

Pancreatic Carcinoma with the First Symptom of Acute Pancreatitis: MRI Findings and Clinical Features

Purpose: To study the MRI findings and clinical features of pancreatic carcinoma with the first symptom of acute pancreatitis. Materials and Methods: Twelve patients with pancreatic carcinoma and the first symptom of acute pancreatitis were included in this study. Pancreatic carcinoma with acute pancreatitis was confirmed by pathology. The MRI findings and clinical features of pancreatic carcinoma combined with acute pancreatitis were noted. Results: In the 12 patients with acute pancreatitis, the pancreas appeared edematous and non-necrotic on MRI. The pancreatic carcinomas were mainly located in the head of the pancreas (83.33%, 10/12). Most patients showed a mass on T1-weighted and T2-weighted images. A dilated pancreatic duct and/or Common Bile Duct (CBD) was observed on MRI of 75% (9/12) of the patients. The results of laboratory tests demonstrated increased CA19-9 in 8 of the patients (66.67%), elevation of both ALP and AST in 11 of the patients (91.67%), and normal ALP and AST levels in 1 patient. Conclusions: Acute pancreatitis may be an indicator of pancreatic carcinoma. A pancreatic mass and a dilated pancreatic duct and/or CBD observed by MRI can provide evidence of the associated pancreatic carcinoma. Increased levels of ALT, AST or ALP and CA19-9 may aid the diagnosis of pancreatic carcinoma in cases of acute pancreatitis.

Clinical value of serum tumor markers CA19-9, CA125 and CA72-4 in the diagnosis of pancreatic carcinoma

CA125 and CA72-4 are members of a family of high-molecular weight glycosylated proteins and are commonly considered as biomarkers in the diagnosis of ovarian and gastric cancer, respectively. However, recent studies have revealed that these two markers may be of clinical value in the diagnosis of pancreatic cancer. As the availability of data regarding CA72-4 and CA125 in the diagnosis of pancreatic cancer is limited, the aim of this study was to investigate the clinical value of serum tumor markers CA19-9, CA125 and CA72-4 in the diagnosis of pancreatic carcinoma according to logistic regression analysis and receiver operating characteristic (ROC) curves and to investigate the correlation of these markers with tumor TNM stage and location. An immunoradiometric assay was used to measure pre-operative serum CA19-9, CA125 and CA72-4 levels in 75 patients with pancreatic carcinoma and 70 patients with benign pancreatic diseases. The concentrations of serum CA19-9, CA125 and CA72-4 in patients with pancreatic carcinoma were found to be significantly higher (P<0.05) compared with those with benign pancreatic diseases. The combined detection of two serum markers (CA19-9 + CA72-4) yielded a ROC value of 0.895 that was significantly higher compared to others (P<0.05) in distinguishing pancreatic cancer from benign pancreatic diseases. At optimal cut-off, the sensitivity and specificity of combined detection (CA19-9 + CA72-4) were 70.6 and 92.8%, respectively. The concentrations of CA125 and CA19-9 in patients with pancreatic adenocarcinoma were found to be significantly higher (P<0.05) compared with those of pancreatic neuroendocrine carcinoma. In conclusion, the combined detection of CA19-9 and CA72-4) may significantly improve the diagnostic specificity and the serum concentrations of CA125 and CA19-9 are correlated with tumor histological type.

Diagnostic accuracy of K-ras mutation for pancreatic carcinoma: a meta-analysis

The conventional tests for the diagnosis of early stage pancreatic carcinoma are not acceptable. This meta-analysis is to evaluate the accuracy of K-ras mutation for the diagnosis of pancreatic carcinoma. A systemic search of all relevant literature was performed in Web of Science, EMBASE, Cochrane Database, and MEDLINE (PubMed as the search engine) prior to June 1, 2011. Thirty-four studies fulfilled the inclusion criteria and data were pooled for analysis. The pooled estimates for K-ras mutation in diagnosis of pancreatic carcinoma were as follows: sensitivity 0.68 (95% CI: 0.66-0.71), specificity 0.87 (95% CI: 0.85-0.88), positive likelihood ratio 4.54 (95% CI: 3.47-5.94), negative likelihood ratio 0.37 (95% CI: 0.30-0.44) and diagnostic odds ratio 14.90 (95% CI: 10.02-22.15). Summary receiver operating characteristic analysis demonstrated that the maximum joint sensitivity and specificity was 0.79, and the overall area under the curve was 0.86. Diagnostic accuracy of K-ras mutation was not superior to that of conventional tests. Therefore, K-ras mutation analysis alone is not recommended for the diagnosis of pancreatic carcinoma.

Application of contrast-enhanced ultrasound in the diagnosis of solid pancreatic lesions—A comparison of conventional ultrasound and contrast-enhanced CT

ObjectiveTo explore the diagnostic value of contrast-enhanced ultrasound (CEUS) by comparison with conventional ultrasound (US) and contrast-enhanced CT (CECT) in solid pancreatic lesions. MethodNinety patients with solid pancreatic focal lesions were enrolled, including 36 cases of pancreatic carcinoma, 28 cases of pancreatitis, 6 cases of pancreatic neuroendocrine tumor, 12 cases of solid pseudopapillary tumor of the pancreas, 6 cases of pancreatic metastases, 1 case of cavernous hemolymphangioma and 1 case of lymphoma. US and CEUS were applied respectively for the diagnosis of a total of 90 cases of solid pancreatic lesions. The diagnostic results were scored on a 5-point scale. Results of CEUS were compared with CECT. Results(1) 3-score cases (undetermined) diagnosed by CEUS were obviously fewer than that of US, while the number of 1-score (definitely benign) and 5-score (definitely malignant) cases diagnosed by CEUS was significantly more than that of US. There was a significant difference in the distribution of final scores using the two methods (p<0.001). The overall diagnostic accuracies of the 90 cases for CEUS and US were 83.33% and 44.44%, respectively, which indicated an obvious advantage for CEUS (p<0.001). (2) The diagnostic consistency among three ultrasound doctors: the kappa values calculated for US were 0.537, 0.444 and 0.525, compared with 0.748, 0.645 and 0.795 for CEUS. The interobserver agreement for CEUS was higher than that for US. (3) The sensitivity, specificity and accuracy of the diagnosis of pancreatic carcinoma with CEUS and CECT were 91.7% and 97.2%, 87.0% and 88.9%, and 88.9% and 92.2%, respectively, while for the diagnosis of pancreatitis, the corresponding indices were 82.1% and 67.9%, 91.9% and 100%, and 88.9% and 90%, respectively, showing no significant differences (p>0.05). ConclusionCEUS has obvious superiority over conventional US in the general diagnostic accuracy of solid pancreatic lesions and in the diagnostic consistency among doctors. The performances of CEUS are similar to that of CECT in the diagnosis of pancreatic carcinoma and focal pancreatitis.

Role of 18F‐fluorodeoxyglucose positron emission tomography/computed tomography in the characterization of pancreatic masses: Experience from tropics

Early detection and differentiation of malignant from benign pancreatic tumors is very essential as mass-forming pancreatitis is a frequently encountered problem. Positron emission tomography (PET) has a role in establishing the diagnosis of pancreatic carcinoma when the conventional imaging modalities or biopsies are nondiagnostic. In this prospective study, the utility of fluorodeoxyglucose (FDG)-PET/computed tomography (CT) in the characterization of mass-forming lesions of the pancreas was reported. (18)F-FDG-PET/CT was prospectively performed in 87 patients diagnosed to have periampullary or pancreatic mass. Lesions with focally increased FDG uptake in PET/CT were considered malignant, whereas those with diffuse or no FDG uptake were considered benign. Semiquantitative analysis with maximum standardized uptake value (SUVmax) was also calculated. The PET/CT results were compared with histopathological results in all patients. Based on the FDG uptake pattern, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for FDG-PET/CT in characterizing the periampullary and pancreatic masses into benign and malignant lesions were 93%, 90%, 95%, 87%, and 92% respectively. Receiver operating characteristics curve analysis of the SUVmax of the lesions yielded a cut-off value of 2.8, with a sensitivity and specificity of 87.5% and 45% respectively. The FDG uptake pattern in PET/CT can differentiate malignant from benign mass-forming lesions of the pancreas with high accuracy and a discrete cut-off value of SUVmax could not be defined for the same as even lesions with pancreatic tuberculosis showed very high FDG uptake. Hence, in patients with a suspicion of malignancy in the pancreas, a focally increase FDG uptake in PET/CT suggests the diagnosis of malignancy.

Pancreatic paraganglioma: An extremely rare entity and crucial role of immunohistochemistry for diagnosis

Paragangliomas are rare neuroendocrine neoplasms arising in extra-adrenal chromaffin cells of autonomic nervous system and histologically akin to chemodectomas. They are rare, affecting about 1 in 2,000,000 population. It is a generic term applied to tumors of paraganglia regardless of the location. In rare instances, paragangliomas present around and involve the pancreas, thereby mimicking any one of the more common primary pancreatic lesions. Pancreatic paraganglioma is an extremely rare tumor. It grows slowly, so radical resection is recommended to achieve curability with good prognosis. These neoplasms present considerable diagnostic difficulty not only for the clinician and radiologist but also for the pathologist. Here, we report a case of a 55-year-old woman who presented with a left-sided abdominal swelling for 3 months duration, initially having clinical suspicion of an ovarian tumor. The radiological imaging revealed a lesion in the tail of pancreas with a differential diagnosis of pancreatic carcinoma and metastatic tumor. Only after exploratory laparotomy, the diagnosis was made as a rare case of pancreatic paraganglioma on the basis of histological examination and immunohistochemistry.

Effects of the Timing and the Type of Venous Thromboembolic Events On Survival in Patients with Pancreatic Cancer

AbstractAbstract 1151 Background:Patients (pts) with pancreatic cancer are at high risk for venous thromboembolic events (VTE) and the occurrence of VTE can adversely affect prognosis. However, it is unclear if the type of VTE such as symptomatic vs incidental, deep vein thrombosis (DVT) vs pulmonary embolism (PE), the location of VTE [DVT of extremities vs visceral veins (abdominal/pelvic veins)] or the timing of VTE from diagnosis can influence the survival. The purpose of this study was to evaluate the incidence of different types of VTE, the impact of types and timing of VTE (early vs late) on survival. Methods:Medical records of 260 pts with pancreatic cancer, newly referred to MDACC in 2006, were reviewed for cancer diagnosis, patient demographics (age, gender), presence of metastasis, the date of diagnosis of VTE, timing of VTE, type of VTE, the site of VTE, the incidence of VTE during 2 years of follow up from the date of diagnosis. Clinical and laboratory parameters predictive for survival were also reviewed. All VTE episodes, including symptomatic as well as incidental VTEs were confirmed by the radiological studies using CT ANGIO, CT scan, Doppler compression ultrasound or V/Q perfusion scans. The survival time was calculated from the date of cancer diagnosis to the date of last follow up. Survival analysis was conducted using Kaplan-Meier method and Cox proportional hazard models. The stepwise selection method was employed to build a multivariate model using variables with p<0.15 in univariate analysis. Results:Of the 260 pts referred, 235 were confirmed to have the diagnosis of pancreatic carcinoma. During the 2-year follow-up, 80 pts (34%) had 109 episodes of VTE, including symptomatic and incidental episodes. The median age of the pts with VTE was 59 years (range: 28–86) and 51% were males. Of the 80 pts with VTE, 21 (26%) had PE, 18 (23%) had DVT of extremities, 28 (35%) had DVT of visceral veins and 13 (16%) had concurrent PE/DVT (diagnosed on the same day). Of the 80 pts, 25 (31%) had 29 recurrent episodes. Kaplan-Meier survival analysis, as shown in the table below, indicated that the pts who had early VTE (defined as VTE diagnosed within 30 days from the date of diagnosis of pancreatic cancer) vs late VTE (> 30 days) and pts with metastasis vs no metastasis had statistically poor 1 year survival (log-rank test).VariablesMedian survival time (days, 95% CI)p valueTiming of VTEEarly116 (84–152)LateNR (262-NR)<0.0001MetastasisYes179 (125–208)NoNR (235-NR)0.006Type of VTESymptomatic196 (123–295)Incidental214 (152–352)0.45NR; not reached.Multivariate proportional hazard analysis demonstrated that early VTE was the independent predictor for survival [hazard ratio 7.3 (95% CI: 3.5–14.9), p<0.0001]. Conclusions:These findings suggest that timing of VTE is an important indicator of prognosis, regardless of whether symptomatic or incidental. Patients with VTE within 30 days of diagnosis have shorter survival. Disclosures:No relevant conflicts of interest to declare.

Genetic and epigenetic markers in the evaluation of pancreatic masses

BackgroundMethylation markers have shown promise in the early diagnosis of pancreatic carcinoma. The aim of this study was to assess the diagnostic utility of hypermethylation status of candidate genes in...

Autoimmune pancreatitis: Assessment of the enhanced duct sign on multiphase contrast-enhanced computed tomography

PurposeTo assess the usefulness of the computed tomography (CT) finding of main pancreatic duct (MPD) wall enhancement, termed the “enhanced duct sign”, for diagnosis of autoimmune pancreatitis (AIP) in comparison with diagnosis of pancreatic carcinoma and chronic pancreatitis. Materials and methodsTwo radiologists independently evaluated the presence or absence of the enhanced duct sign on multiphase contrast-enhanced CT in patients with AIP (n=55), pancreatic carcinoma (n=50), and chronic pancreatitis (n=50). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of AIP were calculated. In patients demonstrating the enhanced duct sign, additional findings were evaluated by consensus. ResultsThe enhanced duct sign was more frequently observed in patients with AIP (37/55, 67%) than in patients with pancreatic carcinoma (5/50, 10%) or chronic pancreatitis (0/50, 0%) (P<0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the finding were 0.67, 0.95, 0.85, 0.88, and 0.84, respectively. In AIP, the lumen within the enhanced duct was completely or partially invisible in 29 of 37 (78%) patients, and the enhanced duct was observed within the affected pancreatic parenchyma in 35 of 37 (95%) patients. In pancreatic carcinoma, the lumen within the enhanced duct was visible in all patients (5/5, 100%), and the enhanced duct was observed downstream of the tumor (5/5, 100%). ConclusionThe enhanced duct sign is highly specific of AIP.

Value of Cytodiagnosis Using Endoscopic Nasopancreatic Drainage for Early Diagnosis of Pancreatic Cancer

We examined the results of pancreatic juice cytodiagnosis using the method of endoscopic nasopancreatic drainage (ENPD) to identify pancreatic carcinoma in situ and compared the images and pathologic diagnosis of pancreatic carcinoma in situ as well as clinicopathologic characteristics. In patients who underwent endoscopic retrograde cholangiopancreatography and had ENPD place, only patients presenting with focal stenosis and distal dilatation of the main pancreatic duct were included in the ENPD placement group. Endoscopic nasopancreatic drainage was conducted 27 times in 20 patients in the ENPD placement group. In an average session, cytodiagnosis of the pancreatic juice was conducted 5.3 times (range, 2-11 times). Results of cytodiagnosis were positive in 15 of 20 patients. Results of ENPD cytodiagnosis and diagnosis of pancreatic cancer showed sensitivity of 100%, specificity of 83.3%, and accuracy of 95%. Seven of 15 patients were diagnosed with carcinoma in situ. In these 7 patients, tumor markers (carcinoembryonic antigen, CA-19-9) were within reference limits, and the tumors were not visible on imaging tests. Pathologic histology revealed a propensity for the cancer to proliferate around the stenosis of the pancreatic duct. Cytodiagnosis of pancreatic juice using ENPD multiple times proved to be useful in the diagnosis of pancreatic carcinoma in situ.

Differentiation of autoimmune pancreatitis with pancreatic carcinoma remains a challenge to physicians

The aim of this study was to summarize the clinical features of autoimmune pancreatitis (AIP) and review the advances in the differential diagnosis with pancreatic carcinoma, thus help to make a correct diagnosis and avoid unnecessary surgery in clinical practice. Five patients diagnosed as AIP in accordance with the HISORt criteria in Zhongshan Hospital, Fudan University from 2008 to 2010 were enrolled in the study. Clinical features were analyzed and related literature was reviewed. Progressive jaundice and abdominal pain were the most frequent symptoms, as well as weight loss, together with serological changes such as elevation of alkaline phosphatase, γ-glutamyl-transpeptidase and serum bilirubin. Two of them showed high serum immunoglobulin G4 (IgG4) levels. Both focal and diffuse changes were found on computed tomography and magnetic resonance imaging. Two of our patients underwent operation because of a high suspicion of malignant tumor, and steroid therapy was administered to the other three patients diagnosed as AIP. No relapse was observed during the follow-up duration of all the patients. Although some recent advances have been made to help the diagnosis of AIP, the differentiation between AIP and pancreatic carcinoma is still a challenge. Clinicians must remember to exclude AIP before making a diagnosis of pancreatic carcinoma.

The expressions and clinical significances of tissue and serum galectin-3 in pancreatic carcinoma

Galectin-3, a member of the beta-galactoside-binding protein family, is involved in many biological processes, including cell proliferation, regulating cell cycle, angiogenesis, tumorigenesis, metastasis, etc. The aim of this study is to elucidate the relationship between galectin-3 and clinicopathological variables and to evaluate the clinical significance of serum galectin-3 in the diagnosis of pancreas carcinoma. Galectin-3 expression in 78 pairs of pancreatic carcinoma tissues and the adjacent nontumorous tissues was tested by immunohistochemistry. The relationship between galectin-3 expression and clinical variables was analyzed. A sensitive method of time-resolved fluorescence immunological assay (TRFIA) for the detection of galectin-3 was established, and serum galectin-3 in cases with different pancreatic diseases was measured by TRFIA and ELISA. Further we compared the sensitivity and specificity of determining galectin-3, carcinoembryonic antigen (CEA) and carbohydrate antigen199 (CA199) for diagnosis of pancreatic carcinoma and assessed the complementary diagnostic value of galectin-3, CEA and CA199 for pancreatic carcinoma. Immunohistochemistry showed that galectin-3 expression was significantly higher in the human pancreatic carcinoma tissues than in the adjacent nontumorous tissues. The expression levels were correlated with the differentiation degree with the higher expression in poor differentiation tissues. Serum galectin-3 detected by both TRFIA and ELISA was much higher in patients with pancreatic carcinoma than in other groups. Serum galectin-3 was not correlated with CEA and CA199. Combined determination of these three markers has the complementary diagnostic value for human pancreatic carcinoma and may increase the diagnostic sensitivity to 97.5%. Galectin-3 is overexpressed in pancreatic carcinoma tissues, and it is correlated with the tumor differentiation. Serum galectin-3 is higher in cases with pancreatic carcinoma than in benign pancreatic diseases and healthy persons. Combined determination of serum galectin-3, CEA and CA199 may improve the diagnostic power for pancreatic carcinoma.

Molecular Biologic Approach to the Diagnosis of Pancreatic Carcinoma Using Specimens Obtained by EUS-Guided Fine Needle Aspiration

We review the utility of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), a rapid, safe, cost-effective, and accurate diagnostic modality for evaluating pancreatic tumors. EUS-FNA is currently used for the diagnosis and staging of pancreatic tumors. The sensitivity of EUS-FNA for pancreatic malignancy ranges from 75% to 94%, and its specificity approaches 100% in most studies. However, EUS-FNA has some limitations in the diagnosis of well-differentiated or early-stage cancers. Recent evidence suggests that molecular biological analysis using specimens obtained by EUS-FNA improves diagnostic sensitivity and specificity, especially in borderline cytological cases. It was also reported that additional information regarding patient response to chemotherapy, surgical resectability, time to metastasis, and overall survival was acquired from the genetic analysis of specimens obtained by EUS-FNA. Other studies have revealed that the analysis of KRAS, MUC, p53, p16, S100P, SMAD4, and microRNAs is helpful in making the diagnosis of pancreatic carcinoma. In this paper, we describe the present state of genetic diagnostic techniques for use with EUS-FNA samples in pancreatic diseases. We also discuss the role of molecular biological analyses for the diagnosis of pancreatic carcinoma.

Significance of combined detection of tumor markers CA199, CA242, CEA and CA125 in the diagnosis of pancreatic carcinoma

目的：探讨肿瘤标志物CA199、CA242、CEA和CA125单项及联合检测在胰腺癌诊断中的价值.方法：检测46例胰腺癌、40例胰腺良性疾病和35例健康人群血清标本中CA199、CA242、CEA和CA125的含量,并对结果进行分析.结果：胰腺癌组血清中CA199、CA242、CEA和CA125的水平明显高于胰腺良性疾病和健康人群组.就单项检测指标而言,CA199诊断胰腺癌的敏感性（82.6%）和特异性CA242（86.4%）均最高,而在联合检测CA199＋CA242＋CEA＋CA125在诊断胰腺癌的敏感性达到90.2%,特异性为100%.结论：在胰腺良恶性疾病鉴别中,CA199、CA242、CEA和CA125联合检测敏感性和特异性都明显高于单项检测.

Cerrahiden Sonra Tanı Alan Eozinofilik Kolesistitin Eşlik Ettiği Otoimmün Pankreatit: Histopatolojik, Radyolojik ve Klinik Yaklaşımla Olgu Sunumu

Autoimmune pancreatitis (AIP) is a special type of chronic pancreatitis that has increasingly been recognized in recent years. We reported a case of AIP which involved mainly the head of the pancreas and the common bile duct, presenting with the features of an accompanying eosinophilic cholecystitis. A 39-year-old woman presented with jaundice, weight loss, and abdominal pain. Radiological examination, together with clinical findings proposed the diagnosis of pancreatic carcinoma. The patient underwent pancreaticoduodenectomy and gross examination of the specimen revealed a firm, mass-like enlargement at the head of the pancreas. Histological findings were characterized by diffuse lymphoplasmacytic infiltration with marked interstitial fibrosis and focal acinar atrophy, obliterative phlebitis of the pancreatic veins, and perineural inflammatory infiltration. Inflammatory component involving the gallbladder was mainly composed of eosinophilic leucocytes. Unfortunately, soon after the operation, the patient started to bleed at the site of gastroenterostomy. Twenty days later, pulmonary thromboemboli developed and the patient died. AIP, which can readily be mistaken for pancreatic carcinoma, may be treated with systemic steroids, if recognized preoperatively. Pathological examination is critical in the evaluation of such cases.

A pilot study to explore circulating tumour cells in pancreatic cancer as a novel biomarker

Background:Obtaining tissue for pancreatic carcinoma diagnosis and biomarker assessment to aid drug development is challenging. Circulating tumour cells (CTCs) may represent a potential biomarker to address these unmet needs. We compared prospectively the utility of two platforms for CTC enumeration and characterisation in pancreatic cancer patients in a pilot exploratory study.Patients and methods:Blood samples were obtained prospectively from 54 consenting patients and analysed by CellSearch and isolation by size of epithelial tumour cells (ISET). CellSearch exploits immunomagnetic capture of CTCs-expressing epithelial markers, whereas ISET is a marker independent, blood filtration device. Circulating tumour cell expression of epithelial and mesenchymal markers was assessed to explore any discrepancy in CTC number between the two platforms.Results:ISET detected CTCs in more patients than CellSearch (93% vs 40%) and in higher numbers (median CTCs/7.5 ml, 9 (range 0–240) vs 0 (range 0–144)). Heterogeneity observed for epithelial cell adhesion molecule, pan-cytokeratin (CK), E-Cadherin, Vimentin and CK 7 expression in CTCs may account for discrepancy in CTC number between platforms.Conclusion:ISET detects more CTCs than CellSearch and offers flexible CTC characterisation with potential to investigate CTC biology and develop biomarkers for pancreatic cancer patient management.