Differential Diagnosis Of Pancreatic Cancer Research Articles

Coagulation parameters for the differential diagnosis of pancreatic cancer in the early stage: a retrospective study

BackgroundIn recent years, conventional coagulation (CC) and thromboelastography (TEG) parameters have been reported to be closely related to the progression of pancreatic cancer (PC). However, the potential utility of these parameters in differentiating benign and malignant pancreatic diseases is still unclear.ObjectivesA retrospective study was conducted to evaluate the efficacy of coagulation parameters in differentiating pancreatic cancer/early stage pancreatic cancer (EPC, TNM stages I and II) from benign control conditions, and to further explore whether coagulation parameters could improve the differential value of CA199.MethodsReceiver operating characteristic (ROC) curves and logistic regression analysis were used to identify the diagnostic value of each coagulation parameter or combination of parameters.ResultsCompared with benign pancreatic disease (BPD), patients with pancreatic malignant tumors had significant coagulation disorders, specifically manifested as abnormal increases or decreases in several CC and TEG parameters (such as activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer (DD2), K time, R time, Angle, maximum amplitude (MA), coagulation index (CI), and Ly30). In the training group, ROC curve showed that FIB, DD2, Angle, MA, and CI had favorable efficacy at differentiating PC or EPC from BPD (for PC, AUC = 0.737, 0.654, 0.627, 0.602, 0.648; for EPC, AUC = 0.723, 0.635, 0.630, 0.614, 0.648). However, several combined diagnostic indicators based on FIB, DD2 and CI failed to outperform the individual coagulation indexes in diagnostic efficiency. Combinations of certain coagulation indexes with CA199 outperformed CA199 alone at identifying PC or EPC, especially FIB + CA199 (for PC, AUC = 0.904; for EPC, AUC = 0.905), FIB + DD2 + CA199 (for PC, AUC = 0.902; for EPC, AUC = 0.900), FIB + CI + CA199 (for PC, AUC = 0.906; for EPC, AUC = 0.906), and FIB + DD2 + CI + CA199 (for PC, AUC = 0.905; for EPC, AUC = 0.900). The results from a validation set also confirmed that these combinations have advantageous diagnostic value for PC and EPC.ConclusionsA significant hypercoagulable state was common in PC. Some CC and TEG parameters are valuable in the differential diagnosis of benign and malignant pancreatic diseases. In addition, coagulation indexes combined with CA199 can further enhance the differential diagnosis efficacy of CA199 in PC and EPC.

Determination of the diagnostic potential of research methods in the differentiation of pancreatic cancer and chronic pancreatitis based on evidence-based medicine

Background. Currently, the use of the principles of evidence-based medicine is an integral part of assessing the effectiveness and safety of modern technology for the diagnosis and treatment of any disease or clinical condition. Differential diagnosis of pancreatic cancer and chronic pancreatitis is one of the most controversial issues in surgical pancreatology. The reduced number of cases of resectable pancreatic cancer indicates the need to develop programs for the differentiation of these pathologies with the wide implementation of modern diagnostic methods.
 Purpose − to compare the results of diagnostic methods (which are standardly used in accordance with clinical guidelines for the diagnosis of chronic pancreatitis) based on evidence-based medicine and quantitative assessments of their specificity, sensitivity, and general accuracy in terms of the differential diagnosis of chronic pancreatitis and pancreatic cancer in order to determine the most significant results for the differentiation of these pathologies.
 Materials and methods. The results of diagnostic methods were compared in 80 patients, among them 38 (47.5%) had pancreatic cancer, and 42 (52.5%) − chronic pancreatitis with predominant lesion of the pancreatic head. The patients underwent general clinical blood and urine tests, biochemical blood tests, and the following procedures and examinations available in the clinic: ultrasound examination of the abdominal organs, spiral computed tomography, fibrogastroduodenoscopy, endoscopic retrograde cholangiopancreatography, magnetic resonance imaging, CA 19-9 tumor marker test, ultrasound-guided percutaneous puncture of the pancreas, aspiration of pancreatic juice, urgent intraoperative biopsy, and histological examination of surgically resected areas of the pancreas. Based on the received data, we performed a comparison of their quality, accuracy, and informativeness.
 Results. Ultrasound imaging is a screening method for suspected pancreatic cancer, however, the overall accuracy, sensitivity, and specificity of the method are quite low (82.5%, 76.32%, 88.10%, respectively). When analyzing the qualitative characteristics of endoscopic retrograde cholangiopancreatography, the overall accuracy, sensitivity, and specificity indicators for the differential diagnosis of pancreatic cancer were 71%, 78.6%, and 63.3%, respectively. The interval assessment of the accuracy of the method of transcutaneous biopsy of the pancreas aimed at determining chronic pancreatitis was (34.9; 96.8)%; for pancreatic cancer – (8.5; 75.5)%. The interval assessment of the accuracy of the method of endoscopic aspiration of pancreatic juice for chronic pancreatitis was (6.8; 93.2)%; for pancreatic cancer – (19.4; 99.4)%. An increase in the level of CA 19-9 was found in 40.5% of patients (CI95% from 27.0% to 55.5%), while the average level was significantly higher in pancreatic cancer. The level of the CA 19-9 tumor marker depended on the size of the tumor and the spread of the process, and during the dynamic observation in the settings of treatment, it had a tendency to decrease, which indicated chronic pancreatitis. The significance of intraoperative morphological verification of the diagnosis of pancreatic cancer in histological examination was 98%, in cytological examination – 95.3%, in 4.7% urgent intraoperative biopsy was questionable. In all examinations, the surrounding tumor tissue showed a morphological pattern of chronic pancreatitis, in 36 (88%) cases – with foci of metaplasia and intraductal neoplasia of the epithelium, which can be considered as a background for the development of intraductal adenocarcinoma. At the same time, cancerous occlusion of the ducts led to their expansion above the point of narrowing with pronounced fibrous changes and inflammatory reaction of the stroma that was accompanied by widespread atrophy of the parenchyma.
 Conclusions. On the basis of evidence-based medicine, it was established that spiral computed tomography is the most informative method for the differential diagnosis of pancreatic cancer with chronic pancreatitis, with an overall accuracy of 92.2%, sensitivity of 89.2%, and specificity of 95%. The low qualitative indicators of ultrasound diagnostics can be increased due to its complex combination with the CA 19-9 tumor marker test with an overall accuracy of 92.3%, with sensitivity and specificity of 95% and 91%, respectively, which is significantly different from such indicators when the method was used separately (82.5%, 76.3%, and 88.1%, respectively). In the cases when the complex combination of endoscopic retrograde cholangiopancreatography with the measurement of the level of the CA 19-9 tumor marker was used, the overall accuracy of the method was 95.2%, with sensitivity of 95% and specificity of 95.5%, which is significantly different from such indicators obtained when the method was used separately (71%, 78.6% and 63.3%, respectively). Advances in modern imaging methods cannot replace histological examination as the «gold standard» for the correct determination of the morphological substrate of these pancreatic lesions.

Differential Diagnosis of Pancreatic Cancer and Chronic Pancreatitis According to Endoscopic Ultrasonography Based on the Analysis of the Nature of the Contours of Focal Formations Based on Fuzzy Mathematical Models.

One of the key echographic signs of focal pathology of the pancreas is the presence of formation contours and their nature. Endoscopic ultrasonography has a unique ability to visualize the echographic texture of the pancreatic parenchyma, and also allows you to assess in detail the boundaries and nature of the contours of the tumor formations of the organ due to the proximity of the ultrasound sensor. However, the differential diagnosis of focal pancreatic lesions remains a difficult clinical task due to the similarity of their echosemiotics. One of the ways to objectify and improve the accuracy of ultrasound data is the use of artificial intelligence methods for interpreting images. Improving the quality of differential diagnosis of focal pathology of the pancreas according to endoscopic ultrasonography based on the analysis of the nature of the contours of focal formations using fuzzy mathematical models.

KRAS Mutations in Peripheral Blood (with or without CA19-9) for Differential Diagnosis of Pancreatic Cancer and Chronic Pancreatitis: a Systematic Review and Meta-analysis

KRAS Mutations in Peripheral Blood (with or without CA19-9) for Differential Diagnosis of Pancreatic Cancer and Chronic Pancreatitis: a Systematic Review and Meta-analysis

Fuzzy Models of the Differential Diagnosis of Pancreatic Cancer and Chronic Pancreatitis Using Endoscopic Ultrasonography Data

Fuzzy Models of the Differential Diagnosis of Pancreatic Cancer and Chronic Pancreatitis Using Endoscopic Ultrasonography Data

Blood biomarkers and computed tomography for differential diagnosis of pancreatic cancer and chronic pancreatitis

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Изучить возможность комплексной дифференциальной диагностики рака поджелудочной железы (РПЖ) и хронического панкреатита (ХП) с применением комбинации онкомаркеров РЭА, CA 19-9 и CA 242 и неинвазивной оценки микроциркуляторного русла при помощи мультиспиральной компьютерной томографии (МСКТ) с внутривенным контрастированием. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В исследование включены 193 больных РПЖ и ХП, проходивших обследование и лечение в отделении патологии поджелудочной железы и желчевыводящих путей ГБУЗ «МКНЦ им. А.С. Логинова ДЗМ» в 2017—2019 гг. <h3>РЕЗУЛЬТАТЫ</h3> Эффективность CA 19-9, CA 242 и РЭА как раздельно интерпретируемых биомаркеров, так и при их совместном использовании оценивали по кривым ROC. При сравнении групп РПЖ и ХП выявлено, что значения чувствительности равны 74%, специфичности — 92%, площадь под кривой (AUC) — 0,83 для CA 19-9; 60%, 82%, 0,71 для CA 242; 68%, 70%, 0,69 для РЭА. При подсчете параметров ROC-кривой при комбинации всех трех онкомаркеров выявлено увеличение AUC до 0,88; чувствительности до 84%, однако наблюдалось некоторое снижение специфичности по сравнению с определением только CA19-9 — 78%. В результате обработки результатов КТ выявлено, что среднее значение Mgrad у пациентов группы РПЖ статистически значимо выше (26,5±8,6 HU), чем у пациентов группы ХП (13,9±5,1 HU), <i>p</i>=0,0001. Анализ полученных значений Mgrad в исследованных группах позволил вычислить пороговое значение для дифференциальной диагностики РПЖ: Mgrad=20 HU. Массив значений Mgrad выше данного показателя статистически значимо чаще отмечен у пациентов с РПЖ (<i>p</i>=0,001). <h3>ЗАКЛЮЧЕНИЕ</h3> Совместное определение в сыворотке крови уровней онкомаркеров CA 19-9, CA 242 и РЭА имеет больший показатель чувствительности и значение AUC ROC-кривой, чем использование одного из указанных онкомаркеров для дифференциальной диагностики рака поджелудочной железы и хронического панкреатита. Мультиспиральная компьютерная томография с внутривенным контрастированием и оценкой Mgrad эффективнее, чем только мультиспиральная компьютерная томография с внутривенным контрастированием для дифференциальной диагностики рака поджелудочной железы и хронического панкреатита.

Blood levels of steroid hormone precursors allow differentiation between pancreatic adenocarcinoma and neuroendocrine tumors.

e16692 Background: The activity of some enzymes involved in the synthesis and transformation of sex hormones changes in some tumor tissues of the pancreas, which can affect the circulating concentrations of these hormones in the blood. The purpose of the study was to determine the possibility of differential diagnosis of pancreatic cancer at primary examination. Methods: Levels of 17OHP and DHEAS were measured by RIA in the blood of 25 men with chronic pancreatitis (CP), 34 patients with pancreatic adenocarcinoma (PA) and 15 patients with pancreatic neuroendocrine tumors (PNET). The results were compared with the levels in 23 healthy donors. All patients gave voluntary informed consent for the study. Results: Men with CP did not show statistically significant changes in 17OHP and DHEAS. The levels in pancreatic cancers were lower than in donors: in PA, DHEAS was 1.6 times and 17OHP - 1.4 times lower than the norm. DHEAS in PNET was 2.4 times lower than the norm and 1.5 times lower than in PA. 17OHP in PNET was 6.4 and 4.5 times lower, respectively. Conclusions: Measuring DHEAS and 17OHP in the blood can serve as an informative laboratory test for predictor assessment of the nature of pancreatic disease.

A case of chronic pancreatitis caused by differential diagnosis of pancreatic cancer

A case of chronic pancreatitis caused by differential diagnosis of pancreatic cancer

Evaluation of different b-values in DWI and 1H MRS for pancreatic cancer and pancreatitis: a rabbit model.

Pancreatic cancer is a common malignant tumor with high incidence of metastasis. Currently, there is no absolute standard for the choice of b-value for diffusion-weighted imaging (DWI) for pancreatic cancer. The b-value is rarely reported in animal model study, especially in pancreatic cancer/mass pancreatitis rabbit models. The authors’ aim was to determine the different b-values to differentiate the diagnosis of pancreatic cancer and mass pancreatitis in rabbit models using DWI. When comparing the effect of different b-values in diagnostic process, the pathological results could be regarded as the gold standard. In this research, 30 healthy New Zealand rabbits were selected and divided into three groups by random number table method: group 1 (pancreatic cancer), group 2 (mass pancreatitis) and the control group (healthy). After DWI (three different b-values 333, 667, 1000 s/mm2, respectively) and MRI examination, the model rabbits were then killed. Afterward, the tumor mass was removed for biopsy, and occupation anatomy and tumor histopathology were examined. Fat-suppressing sequences of T2WI, DWI, ADC, difference of ADC (DADC), and MRS were used. The present study determined that the effective differential diagnosis of pancreatic cancer and pancreatitis was determined at low b-values (333 s/mm2) when performed DWI inspection in rabbit models.

Establishment and Verification of a Scoring Model for the Differential Diagnosis of Pancreatic Cancer and Chronic Pancreatitis.

The aims of this study were to establish a scoring model for the differential diagnosis of pancreatic cancer (PC) and chronic pancreatitis (CP) and to evaluate its diagnostic efficacy. The data of 502 patients with PC and 210 patients with CP at the Peking Union Medical College Hospital from January 1999 to December 2013 were retrospectively analyzed. Binary logistic regression was applied to establish the prediction model for the differential diagnosis. The model was verified using the method of leave-one-out cross-validation. The scoring system was established with 5 variables including age, carbohydrate antigen 19-9 level, splenic vein invasion, irregular dilatation of the pancreatic duct, and nontruncated pancreatic duct stenosis. The score range was from -2 to 3. The area under the receiver operating characteristic curve of the objects was 0.779 (95% confidence interval, 0.744-0.814) (P < 0.01), indicating that the scoring system is good at differentiation of PC with CP. With a score of 1 as the diagnostic cut-off value, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate were 71.3%, 69.0%, 70.0%, 71.4%, and 70.2%, respectively. The scoring model may improve the differential diagnosis of PC and CP and be useful in clinical practice.

Value of adipokines in the diagnosis and prognosis of pancreatic cancer complicated with diabetes

Objective To detect and analyze the value of adipokines in the diagnosis and prognosis of patients with pancreatic cancer complicated with diabetes. Methods From July 2012 to June 2013, 24 pancreatic ductal adenocarcinoma (PDAC) complicated with diabetes mellitus (DM) (study group), 30 PDAC (control group A) and 31 DM (control group B) cases were collected. Serum levels of adiponectin, resistin, leptin and visfatin were tested and the differences were compared among different groups. Receiver operator characteristic (ROC) curves were used to analyze the diagnostic value of the above cytokines. The patients were followed up for two to 58 months. Kaplan-Meier survival curve was performed to analyze the prediction value of above cytokines in recurrence-free survivals (RFS) in patients with PDAC complicated with DM. Chi square test, t test and Mann-Whitney U test were used for statistical analysis. Results The median levels of serum adiponectin and resistin of study group were both higher than those of control group B (36.92 mg/L , 15.80 mg/L to 101.57 mg/L vs 12.84 mg/L, 5.64 mg/L to 21.39 mg/L; 9.07 μg/L, 6.39 μg/L to 12.19 μg/L vs 5.93 μg/L, 4.22 μg/L to 7.68 μg/L, respectively), and the differences were statistically significant (Z=-3.462 and -2.868, P=0.001 and 0.004, respectively). However the serum levels of leptin and visfatin of study group were both lower than those of control group B (1.02 μg/L, 0.11 μg/L to 2.06 μg/L vs 1.92 μg/L, 0.96 μg/L to 2.72 μg/L; 2.43 μg/L, 0.48 μg/L to 4.28 μg/L vs 4.18 μg/L, 2.43 μg/L to 7.28 μg/L), and the differences were statistically significant (Z=-1.986 and -2.336, both P<0.05). The results of ROC curve analysis of adipokines in differential diagnosis of pancreatic cancer from diabetes indicated that the areas under the curve (95% confidence interval) of serum adiponectin, resistin, leptin and visfatin in the diagnosis of PDAC were 0.774 (0.645, 0.903), 0.727 (0.593, 0.861), 0.657 (0.504, 0.810) and 0.685 (0.543, 0.826), respectively, with statistical significance (P=0.001, 0.004, 0.047 and 0.020, respectively). The sensitivity of combination of CA19-9 and adiponectin in the diagnosis of PDAC complicated with DM was 0.917 and the negative predictive value was 0.940. The leptin level in advanced PDAC patients was lower than that in non advanced PDAC patients (0.61 μg /L, 0.11 μg /L to 2.28 μg /L vs 1.86 μg /L, 0.79 μg /L to 4.14 μg /L); and the difference was statistically significant (Z=-2.210, P=0.027). Higher serum adiponectin level was correlated with early recurrence after operation in PDAC patients complicated with DM (P=0.035). Conclusions Serum adipokines may be valuable in screening PDAC in patients with DM. And adipokines may be valuable in the prediction of recurrence after operation in PDAC patients complicated with DM. Key words: Adipokines; Pancreatic neoplasms; Diabetes mellitus; Biological markers

Differential Diagnosis of Pancreatic Cancer by Endoscopic Ultrasound-guided Fine-needle Aspiration in Solid Mass of Pancreas

Differential Diagnosis of Pancreatic Cancer by Endoscopic Ultrasound-guided Fine-needle Aspiration in Solid Mass of Pancreas

Contrast-enhanced endoscopic ultrasound for differential diagnosis of pancreatic cancer: an updated meta-analysis.

AimWe aim to assess the diagnostic value of contrast-enhanced endoscopic ultrasound (CE-EUS) for pancreatic cancer and inflammatory lesions by pooling current evidence.Materials and MethodsA systematical search of PubMed, Web of Science and the Cochrane Library was performed from inception to January 2016. Two authors independently screened and extracted detailed data from included studies. A random effect model was adopted to estimate the pooled sensitivity, specificity in order to determine the diagnostic ablitity of CE-EUS. Furthermore, we conducted the meta-regression and subgroup analyses to explore possible heterogeneity.ResultsEighteen eligible studies enrolling 1668 patients were finally included in the study. The pooled sensitivity of CE-EUS for distinguishing pancreatic cancers from solid inflammatory masses was 0.93 (95% CI, 0.91–0.94), and the specificity was 0.88 (95% CI, 0.84–0.90). The area under summary receiver operating characteristic curve yielded 0.97. No publication bias was observed by Deeks’ funnel plot in current meta-analysis.ConclusionsWe provided evidence that CE-EUS is a promising modality for differential diagnosis of pancreatic adenocarcinomas. Further multicenter prospective studies should be carried out to certify its utility.

Diagnosis and treatment of autoimmune pancreatitis

Diagnosis and treatment of autoimmune pancreatitis

Pathologic characteristics of pancreatic cancer in Shanghai urban area:preliminary analysis of 350 cases

Objective:To investigate the pathologic characteristics and differential diagnosis of pancreatic cancer among residents in Shanghai urban area.Methods:A population-based large case-control study was performed in patients with pancreatic cancer between December 2006 and January 2011 in Shanghai urban area.The pathologic slides from 387 cases of pancreatic cancer were collected and reviewed by five experienced pathologists.The pathologic diagnosis was determined according to WHO Classification of Tumors of the Digestive System,Fourth Edition(2010).Results:Three hundred and fifty cases(90.4%) were confirmed as pancreatic cancer.Most of the pathologic slides were obtained from resected tissues of pancreatic cancer(311/350,88.9%).The average diameter of the tumor was 4 cm,and 56.6%(n = 198) of the tumors were located in the head of pancreas.The ductal adenocarcinoma was the most common histologic subtype(n = 311,89.0%),followed by pancreatic neuroendocrine tumors(n = 15,4.3%).The most common histologic grades were Ⅱ/Ⅲ(n = 252).According to TNM staging system,40 cases had stage ⅠA,209 cases had stages ⅠB/ⅡA,and 80 cases had stage ⅡB.The perineural invasion was identified in 175 cases,and the lymphovascular and/or venous emboli were identified in 56 cases.Only one case was misdiagnosed.Conclusion:The understanding of pathology of pancreatic cancer in Shanghai urban area was improved through this pathologic review.

Differential diagnosis of pancreatic cancer by single-shot echo-planar imaging diffusion-weighted imaging.

To investigate the diagnostic ability of single-shot echo-planar imaging (EPI) diffusion-weighted imaging (DWI) to differentiate between malignant and benign pancreatic lesions. A computerized search was performed on PubMed, MEDLINE and EMBASE up to August 2014. Nine studies (10 sets of data) with a total of 304 malignant pancreatic lesions and 188 benign pancreatic lesions were included. The characteristics of each study included the study name, year of publication, magnetic resonance modalities used, patient population, strength of field, pulse time, repetition time, echo time (TE), maximum b factor, mean age, mean body weight, fat suppression, number of benign and malignant lesions, and true positive, true negative, false positive and false negative results. All analyses were performed using Meta-DiSc and Stata 11.0. The pooled sensitivity and specificity of single-shot EPI DWI were 0.83 (95%CI: 0.79-0.87) and 0.77 (95%CI: 0.70-0.83), respectively. The positive likelihood ratio and negative likelihood ratio were 5.09 (95%CI: 2.19-11.84) and 0.23 (95%CI: 0.15-0.36), respectively. The P value for the χ(2) heterogeneity for all pooled estimates was < 0.05. From the fitted summary receiver operating characteristic curve, the area under the curve and Q* index were 0.89 and 0.82, respectively. Publication bias was not present (t = 0.58, P = 0.58). Meta-regression analysis indicated that fat suppression, mean age, TE, and maximum b factor were not sources of heterogeneity (all P > 0.05). Single-shot EPI DWI is useful to differentiate between malignant and benign pancreatic lesions. Lesion size ≥ 2 cm is the limit for the diagnosis of early lesions.

Up-regulation of UHRF1 by oncogenic Ras promoted the growth, migration, and metastasis of pancreatic cancer cells.

Ubiquitin-like with PHD and ring finger domains 1 (UHRF1) has been reported as a marker for the differential diagnosis of pancreatic cancer and chronic pancreatitis. However, the expression pattern and biological functions of UHRF1 in the progression of pancreatic cancer are not fully understood. In this study, it was found that the expression of UHRF1 was significantly up-regulated in pancreatic cancer samples compared to their adjacent normal tissues. Meanwhile, the expression of UHRF1 was inversely correlated with the survival of pancreatic cancer patients. Moreover, in the biological function studies, UHRF1 was shown to promote the growth, migration, and metastasis of pancreatic cancer cells in vitro and in vivo. Mechanistically, the expression of UHRF1 was induced by oncogenic Ras in both pancreatic cancer mouse model and cultured cells. Taken together, our study demonstrated that UHRF1 played an oncogenic role in the progression of pancreatic cancer, and UHRF1 might be a promising target for the treatment of pancreatic cancer.

Circulatory biomarkers for the differential diagnosis of pancreatic cancer and chronic pancreatitis

Circulatory biomarkers for the differential diagnosis of pancreatic cancer and chronic pancreatitis

Focal autoimmune pancreatitis versus pancreatic cancer: value of steroid treatment in the diagnosis

The differential diagnosis of pancreatic cancer and focal forms of autoimmune pancreatitis is complicated since serological tests, IgG4 and CA 19-9 have a low sensibility and specificity. CT scan and magnetic resonance imaging provide clear differentiation in the majority, but not in all cases. Endosonography is the most precise diagnostic procedure and allows to obtain samples for cytology or even histological studies. To report the experience with 18 cases of focal autoimmune pancreatitis and three cases of pancreatic cancer. Review of medical records of 18 patients with focal autoimmune pancreatitis and 3 cases of pancreatic cancer. The eighteen patients with focal autoimmune pancreatitis were treated with prednisone 0.5 mg/kg/day obtaining a complete clinical and morphological recovery in all. However, 3 had a relapse and one was operated. During follow up, none has developed a pancreatic cancer. The 3 patients with pancreatic cancer did not respond to steroidal treatment. The quick and dramatic response to steroids of autoimmune pancreatitis, may be useful and is recommended for the differential diagnosis with pancreatic cancer.

Detection of pancreatic cancer with normal carbohydrate antigen 19-9 using protein chip technology.

To develop a method to differentiate pancreatic cancer patients from healthy or benign individuals when carbohydrate antigen (CA) 19-9 is normal. Forty-one serum samples from patients with pancreatic lesions and blood samples from 20 healthy individuals were collected at the first stage of the experiment according to the enrolment criteria. General characteristics and some clinical features were carefully compared to ensure that the results were reasonable. All the blood samples were analyzed by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS) combined with CM10 chips and a related bioinformatics analysis program to generate diagnostic models with different proteins. Forty-seven consecutive samples were tested at the next stage to verify the veracity and efficiency of the models. The sex, age, and serum CA19-9 levels among the three groups (malignant, benign, and healthy) were statistically matched (P values were 0.957, 0.145, and 0.382, respectively). Two patterns were generated. Pattern 1 with four proteins theoretically had a specificity and sensitivity of 100% in distinguishing pancreatic cancer from healthy individuals, while it was 86.7% and 86.4%, respectively, in the subsequent practical verification. The positive predictive value (PPV) of the model was 86.4%. One of the four proteins was expressed highly in pancreatic cancer while the other three were expressed weakly. Pattern 2 consisted of six proteins that showed a specificity of 70.0% and sensitivity of 77.3% for differentiating malignancy from benign tumors. Its PPV reached 85.0%. Only one of these six proteins showed high expression in the malignant group. SELDI-TOF-MS may facilitate diagnosis or differential diagnosis of pancreatic cancer when CA19-9 is normal. Pattern 1 may serve as a useful screening tool.