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Annals of Surgery logoLink to Annals of Surgery
. 1979 Apr;189(4):480–487.

Non-operative differentiation between pancreatic cancer and chronic pancreatitis.

C R Mackie, M J Cooper, M H Lewis, A R Moossa
PMCID: PMC1397264  PMID: 443902

Abstract

Eighty-five of 186 patients investigated for suspected pancreatic cancer had an unequivocal final diagnosis of either pancreatic cancer (58 patients) or chronic pancreatitis (27 patients). They had been studied prospectively using ultrasonography, computerized tomography, radionuclide scanning, endoscopic retrograde cholangiopancreatography (ERCP), selective celiac and superior mesenteric angiography, duodenal drainage studies, cytologic studies, serum carcinoembryonic antigen assay, and pancreatic oncofetal antigen assay, The results were compared to determine which test would most frequently and reliably differentiate between pancreatic cancer and pancreatitis in a patient believed to have one or other disease. Criteria for interpreting results, first for highest rate of correct diagnoses, and second for highest accuracy were derived. Applying these criteria, ultrasonography achieved the highest rate of correct diagnoses (97% of patients diagnosed with 84% accuracy). ERCP, duodenal drainage studies, and cytology were the most accurate tests ((86% accuracy each test) but, with this accuracy, ERCP most frequently gave a diagnosis (diagnosis rate: ERCP--70%, duodenal drainage--32%, cytology--35%). The results suggest that ultrasonography is the best noninvasive test, and that a combination of ERCP, pancreatic juice assay and cytology in a single procedure may prove to be the best discriminating investigation.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adler M., Waye J. D., Dreiling D. The pancreas, a correlation of function, structure and histopathology. Acta Gastroenterol Belg. 1976 Nov-Dec;39(11-12):502–508. [PubMed] [Google Scholar]
  2. Barkin J., Vining D., Miale A., Jr, Gottlieb S., Redlhammer D. E., Kalser M. H. Computerized tomography, diagnostic ultrasound, and radionuclide scanning. Comparison of efficacy in diagnosis of pancreatic carcinoma. JAMA. 1977 Nov 7;238(19):2040–2042. [PubMed] [Google Scholar]
  3. Blackstone M. O., Cockerham L., Kirsner J. B., Moossa A. R. Intraductal aspiration for cytodiagnosis in pancreatic malignancy. Gastrointest Endosc. 1977 Feb;23(3):145–147. doi: 10.1016/s0016-5107(77)73620-x. [DOI] [PubMed] [Google Scholar]
  4. Cooper M. J., Moossa D. E., Cockerham L., Hall T. J., Levin B., Moossa A. R. The place of duodenal drainage studies in the diagnosis of pancreatic disease. Surgery. 1978 Oct;84(4):457–464. [PubMed] [Google Scholar]
  5. Dilawari J. B., Philippakos D., Blendis L. M., Waller S. L. Carcinoembryonic antigen in differential diagnosis of carcinoma of pancreas from chronic pancreatitis. Br Med J. 1975 Jun 21;2(5972):668–668. doi: 10.1136/bmj.2.5972.668. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Feinberg S. B., Schreiber D. R., Goodale R. Comparison of ultrasound pancreatic scanning and encoscopic retrograde cholangiopancreatograms: a retrospective study. J Clin Ultrasound. 1977 Apr;5(2):96–100. doi: 10.1002/jcu.1870050211. [DOI] [PubMed] [Google Scholar]
  7. Fredens M., Egeblad M., Holst-Nielsen F. The value of selective angiography in the diagnosis of tumors in pancreas and liver. Radiology. 1969 Oct;93(4):765–769. doi: 10.1148/93.4.765. [DOI] [PubMed] [Google Scholar]
  8. Gelder F. B., Reese C. J., Moossa A. R., Hall T., Hunter R. Purification, partial characterization, and clinical evaluation of a pancreatic oncofetal antigen. Cancer Res. 1978 Feb;38(2):313–324. [PubMed] [Google Scholar]
  9. Haaga J. R., Alfidi R. J., Havrilla T. R., Tubbs R., Gonzalez L., Meaney T. F., Corsi M. A. Definitive role of CT scanning of the pancreas. The second year's experience. Radiology. 1977 Sep;124(3):723–730. doi: 10.1148/124.3.723. [DOI] [PubMed] [Google Scholar]
  10. Hall T. J., Cooper M., Hughes R. G., Levin B., Skinner D. B., Moossa A. R. Pancreatic cancer screening. Analysis of the problem and the role of radionuclide imaging. Am J Surg. 1977 Nov;134(5):544–548. doi: 10.1016/0002-9610(77)90430-5. [DOI] [PubMed] [Google Scholar]
  11. Holm H. H., Smith E. H., Bartrum R. J., Jr The relationship of computed tomography and ultrasonography in diagnosis of abdominal disease. J Clin Ultrasound. 1977 Aug;5(4):230–237. doi: 10.1002/jcu.1870050404. [DOI] [PubMed] [Google Scholar]
  12. Kawanishi H., Sell J. E., Pollard H. M. Combined endoscopic pancreatic fluid collection and retrograde pancreatography in the diagnosis of pancreatic cancer and chronic pancreatitis. Gastrointest Endosc. 1975 Nov;22(2):82–85. doi: 10.1016/s0016-5107(75)73707-0. [DOI] [PubMed] [Google Scholar]
  13. Nebesar R. A., Pollard J. J. A critical evaluation of selective celiac and superior mesenteric angiography in the diagnosis of pancreatic diseases, particularly malignant tumor: facts and "artefacts". Radiology. 1967 Dec;89(6):1017–1027. doi: 10.1148/89.6.1017. [DOI] [PubMed] [Google Scholar]
  14. Ponette E., Pringot J., Baert A. L., Marchal G., Dardenne A. N., Coenen Y. Computerized tomography and ultrasonography in pancratitis. Acta Gastroenterol Belg. 1976 Nov-Dec;39(11-12):402–404. [PubMed] [Google Scholar]
  15. Smithies A., Hatfield A. R., Brown B. E. The cytodiagnostic aspects of pure pancreatic juice obtained at the time of endoscopic retrograde cholangio-pancreatography (E.R.C.P.) Acta Cytol. 1977 Mar-Apr;21(2):191–195. [PubMed] [Google Scholar]
  16. Walls W. J., Gonzalez G., Martin N. L., Templeton A. W. B-scan ultrasound evaluation of the pancreas. Advantages and accuracy compared to other diagnostic techniques. Radiology. 1975 Jan;114(1):127–134. doi: 10.1148/114.1.127. [DOI] [PubMed] [Google Scholar]
  17. Wood R. A., Hall A. W., Moossa A. R., Levin B., Skinner D. B. Pancreatic cancer diagnosis: preliminary evaluation of a prospective study. J Surg Res. 1976 Aug;21(2):113–115. doi: 10.1016/0022-4804(76)90069-x. [DOI] [PubMed] [Google Scholar]
  18. Wood R. A., Moossa A. R. The prospective evaluation of tumour-associated antigens for the early diagnosis of pancreatic cancer. Br J Surg. 1977 Oct;64(10):718–720. doi: 10.1002/bjs.1800641009. [DOI] [PubMed] [Google Scholar]

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