RESUMEN
A prospective study of 277 patients with benign (n = 212) and malignant (n = 65) hepatopancreatobiliary disease was carried out to evaluate the value of six serum tumour markers (CEA, CA 50, CA 242, TPA, TPS, TATI) and 16 conventional laboratory tests in the distinction between benign and malignant diseases. In univariate analysis, all tumour marker tests except TATI showed significantly (p < 0.001) higher serum values in the patients with malignant disease than in the patients with benign disease. Among the conventional laboratory tests serum bilirubin, alkaline phosphatase and leucine aminopeptidase showed significantly. (p < 0.001) higher values in the patients with malignant disease, whereas serum protein and amylase levels were significantly (p < 0.01) higher in the patients with benign disease. In a multivariate analysis, serum bilirubin (p < 0.001), antithrombin III (p < 0.01) and blood hemoglobin (p < 0.05) were the most significant independent predictors of hepatopancreatobiliary malignancy. To sum up the contributions of the best tests a diagnostic score (DS) was developed. The sensitivity of DS in detecting malignancy was 73% with a specificity of 82% and an efficiency of 79%. In conclusion, our results speak against the use of multiple tumour marker tests, and rather suggest the use of a relatively limited amount of conventional laboratory tests in the distinction between benign and malignant hepatopancreatobiliary disease.
Asunto(s)
Antígenos de Neoplasias/sangre , Neoplasias del Sistema Biliar/sangre , Biomarcadores de Tumor/sangre , Proteínas Sanguíneas/análisis , Pruebas Diagnósticas de Rutina , Neoplasias Hepáticas/sangre , Neoplasias Pancreáticas/sangre , Fosfatasa Alcalina/sangre , Amilasas/sangre , Antígenos de Carbohidratos Asociados a Tumores/sangre , Antitrombina III/análisis , Neoplasias del Sistema Biliar/diagnóstico , Bilirrubina/sangre , Sedimentación Sanguínea , Antígeno Carcinoembrionario/sangre , Diagnóstico Diferencial , Análisis Discriminante , Hemoglobinas/análisis , Humanos , Ictericia/sangre , Ictericia/diagnóstico , Leucil Aminopeptidasa/sangre , Neoplasias Hepáticas/diagnóstico , Análisis Multivariante , Neoplasias Pancreáticas/diagnóstico , Péptidos/sangre , Estudios Prospectivos , Antígeno Polipéptido de Tejido , Inhibidor de Tripsina Pancreática de Kazal/sangreRESUMEN
The aim of this study was to assess by a stepwise multivariate discriminant analysis the value of four current serum tumour markers - carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 50 and CA 242 and tissue polypeptide antigen (TPA) - and a new serum tumour marker, tissue polypeptide specific antigen (TPS), in the diagnosis of pancreatic cancer. The serum values were measured in a prospective series of patients with jaundice, with unjaundiced cholestasis and with a suspicion of chronic pancreatitis or a pancreatic tumour (n = 193). There were 24 patients with a cancer of the pancreas and two patients with a cancer of the papilla of Vater in this series. Our results showed that CA 50 (P < 0.001) and TPA (P < 0.01) were the best marker tests in predicting pancreatic malignancy. Also, the TPS (P = 0.07) and CA 242 (P = 0.08) tests showed marginally significant independent discriminating power, while the CEA test did not (P = 0.12). In order to sum up the contributions of different markers, a diagnostic score (DSI) was developed. The discrimination function was: DS1 = CA 50 x 1.75 + TPA x 0.62 + TPS x (-0.37) + CA 242 x (-1.21). The sensitivity of DS1 in detecting pancreatic cancer was 36% with a specificity of 90% and an efficiency of 82%. When the combination of CA 50 and TPA was used as a test, the discrimination function (DS2) was: DS2 = CA 50 x 0.69 + TPA x 0.67. The sensitivity of DS2 was 44% with a 88% specificity and an efficiency of 82%. According to this analysis, the further advantage gained by a computer-aided scoring system seems to be limited, since despite the considerably high specificity and efficiency its sensitivity remained low. In the present analysis the best combination in diagnosing pancreatic cancer was the combination of CA 50 and TPA.
Asunto(s)
Antígenos de Carbohidratos Asociados a Tumores/sangre , Biomarcadores de Tumor/sangre , Antígeno Carcinoembrionario/sangre , Neoplasias Pancreáticas/diagnóstico , Péptidos/sangre , Adulto , Diagnóstico Diferencial , Análisis Discriminante , Enfermedades de la Vesícula Biliar/diagnóstico , Humanos , Hepatopatías/diagnóstico , Análisis Multivariante , Enfermedades Pancreáticas/diagnóstico , Neoplasias Pancreáticas/sangre , Estudios Prospectivos , Antígeno Polipéptido de TejidoRESUMEN
The purpose of this study was to investigate the diagnostic accuracy of ultrasound (US), computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) in the distinction between extrahepatic and intrahepatic causes of unjaundiced cholestasis. Moreover, attention was paid to the ability of these methods to distinguish between benign and malignant causes of obstruction. The inclusion criteria of laboratory values suggesting cholestasis were serum alkaline phosphatase 350 U/l and gammaglutamyl transpeptidase 100 U/l or liver-specific alkaline phosphatase elevated. The diagnostic value of the imaging methods was tested in 33 patients. The most common cause of unjaundiced obstruction was choledochal stone disease. The diagnostic sensitivities of US, CT and ERCP for the detection of extrahepatic cholestasis were 53%, 53% and 79%, respectively. In patients on whom all three imaging studies were done (n = 20), the difference between US and ERCP was statistically significant (p > 0.05). The specificities of US, CT and ERCP were 100%, 86% and 90%, respectively. CT was better than US in defining the benign nature of obstruction, but ERCP was superior in this respect. In malignant obstructions CT was comparable to ERCP. In conclusion, ERCP seems to be considerably sensitive for the detection of extrahepatic obstruction in cases of unjaundiced cholestasis, whereas US and CT are rather insensitive. The specificity of all these imaging methods is high. The results are in favour of CT as the best noninvasive investigation method, and also indicate the important role of ERCP. However, in many cases all three imaging methods are needed, and a flexible and complementary use of them is recommended.
Asunto(s)
Colangiopancreatografia Retrógrada Endoscópica , Colestasis Extrahepática/diagnóstico , Colestasis Intrahepática/diagnóstico , Tomografía Computarizada por Rayos X , Carcinoma Papilar/diagnóstico , Colestasis Extrahepática/diagnóstico por imagen , Colestasis Intrahepática/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Masculino , Neoplasias Pancreáticas/diagnóstico , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y Especificidad , UltrasonografíaRESUMEN
The serum values of tumour-associated trypsin inhibitor (TATI) were measured in a prospective series of 97 patients with jaundice, 36 patients with unjaundiced cholestasis and 21 patients with suspicion of chronic pancreatitis or a pancreatic tumour, to assess its value in diagnosing pancreatic cancer. There were altogether 15 patients with cancer of the pancreas and 2 patients with cancer of the papilla of Vater. The highest serum TATI values were noticed in patients with choledocholithiasis, and raised values were also seen in patients with malignant disease of the liver or bile ducts. In the patients with pancreatic cancer, chronic pancreatitis or benign liver disease, the serum TATI values showed lower levels. The sensitivity of TATI in diagnosing pancreatic cancer was 41.1% with a specificity of 63.5% and an efficiency of 61.0%. In comparison to carcinoembryonic antigen (CEA), carbohydrate antigens CA 50, CA 242, tissue polypeptide antigen and tissue polypeptide-specific antigen, TATI showed a lower diagnostic value. When TATI was analysed in combination with the other markers (two tests positive), the combination of CEA with TATI reached the highest specificity (95.6%), efficiency (89.6%) and positive likelihood ratio (9.3). The results suggest that the diagnostic value of TATI is inferior to that of the established markers, but because of its different nature, it may be of help when used in combination as a complementary serum tumour marker in the diagnosis of pancreatic cancer.
Asunto(s)
Biomarcadores de Tumor , Neoplasias Pancreáticas/diagnóstico , Inhibidores de Tripsina/sangre , Antígenos de Carbohidratos Asociados a Tumores/sangre , Antígeno Carcinoembrionario/sangre , Estudios de Evaluación como Asunto , Humanos , Ictericia/etiología , Hepatopatías/sangre , Enfermedades Pancreáticas/sangre , Neoplasias Pancreáticas/sangre , Pancreatitis/sangre , Estudios ProspectivosRESUMEN
We evaluated the clinical utility of a new tumor marker tissue polypeptide specific antigen (TPS) in the diagnosis of pancreatic carcinoma. Serum concentrations were determined in 113 patients with jaundice, in 18 patients with laboratory values suggesting cholestasis and in 60 patients with suspicion of chronic pancreatitis or pancreatic tumor. Twenty-four of these 191 patients had pancreatic carcinoma and 2 patients had carcinoma of the papilla of Vater. The highest median serum TPS value was detected in patients with malignant liver disease, but high median values were also measured in patients with pancreatic cancer, bile duct cancer or benign liver disease. The sensitivity of TPS was 50.0%, with a specificity of 73% and an efficiency of 70%. In comparison with carcinoembryonic antigen (CEA), CA 50 and CA 242, the TPS test showed lower sensitivity, but the differences in specificity and negative predictive value were considerably smaller. The utility of TPS as a complementary test was also analyzed. When TPS was combined with other marker tests, their specificities clearly improved, being highest in the combination of TPS and CA 242 (92.5%). In this combination, efficiency and positive likelihood ratio were also clearly better (85% and 5.6) than those of the marker tests alone. In conclusion, TPS seems less accurate than CEA, CA 50 or CA 242 in the diagnosis of pancreatic cancer, but because of its different nature it may be considered to be used as a complementary test.
Asunto(s)
Neoplasias Pancreáticas/diagnóstico , Péptidos/sangre , Biomarcadores de Tumor/sangre , Colestasis/sangre , Humanos , Ictericia/sangre , Enfermedades Pancreáticas/sangre , Neoplasias Pancreáticas/sangre , Antígeno Polipéptido de TejidoRESUMEN
The serum values of tissue polypeptide antigen (TPA) were measured in a prospective series of 100 patients with jaundice, 54 patients with suspicion of chronic pancreatitis or a pancreatic tumour, and 19 patients with unjaundiced cholestasis to assess its value in diagnosing pancreatic cancer. There were altogether 25 patients with a cancer of the pancreas including 2 patients with a cancer of the papilla of Vater. The highest serum TPA values were noticed in patients with pancreatic cancer, but raised values were also seen in patients with malignant or benign liver diseases, and with cholangiocarcinoma. The sensitivity of TPA was 52% with a specificity of 85% and an efficiency of 80%. In comparison to CEA, CA 50 and CA 242, TPA showed lower sensitivity but higher specificity. When TPA was combined with the other markers, the specificity and efficiency improved clearly in all combinations, being highest in that of TPA and CA 242 (specificity 94.5%, efficiency 87.2%). The results suggest that the TPA test has a useful complementary role in the clinical use of the current serum tumour markers in the diagnosis of pancreatic cancer.
Asunto(s)
Carcinoma/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Péptidos/análisis , Fosfatasa Alcalina/sangre , Antígenos de Carbohidratos Asociados a Tumores/análisis , Neoplasias del Sistema Biliar/diagnóstico , Bilirrubina/sangre , Biomarcadores de Tumor/análisis , Antígeno Carcinoembrionario/análisis , Humanos , Enfermedades Pancreáticas/diagnóstico , Estudios Prospectivos , Antígeno Polipéptido de TejidoRESUMEN
A prospective series of 220 patients with jaundice and/or cholestasis was analysed by means of discriminant analysis to evaluate the diagnostic value of various symptoms and signs and basic hepatopancreatobiliary laboratory tests in the differential diagnosis of these patients. In addition, a computer-based diagnostic score (DS) system was developed and compared with the diagnostic value of clinical evaluation (CE), ultrasound (US), computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP). A multivariate stepwise discriminant analysis showed five independent diagnostic factors in distinguishing extrahepatic and intrahepatic diseases: duration of jaundice (p = 0.002), serum protein concentrations (p = 0.002), Normotest (p = 0.04), fever during the past 3 months (p = 0.54), and age (p = 0.58). To sum up the contributions of independent factors, a DS was developed. The discrimination function was as follows: duration of jaundice x 0.97 + age x -0.40 + fever during the past 3 months x 0.33 + serum protein concentration x 0.35 + Normotest x -0.27. The diagnostic sensitivity of DS in the detection of extrahepatic disease was 96%, with a specificity of 80% and an efficiency of 93%. The sensitivities of the imaging methods (62-85%) were inferior to that of DS, whereas the specificities were better (94-98%). The sensitivity of CE was only slightly lower (86%) than that of DS, but the specificity was lowest (57%). In conclusion, relatively few (5 of 40) of the classical symptoms, signs, and biochemical tests proved to be independent diagnostic factors in distinguishing extrahepatic and intrahepatic diseases.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Colestasis Extrahepática/diagnóstico , Colestasis Intrahepática/diagnóstico , Toma de Decisiones Asistida por Computador , Colestasis Extrahepática/epidemiología , Colestasis Intrahepática/epidemiología , Diagnóstico por Imagen , Análisis Discriminante , Estudios de Evaluación como Asunto , Femenino , Humanos , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
We studied a combined utilization of serum tumour markers and proton nuclear magnetic resonance 1H NMR spectroscopy of plasma in the detection of pancreatic cancer. Serum concentrations of carcinoembryonic antigen (CEA), carboanhydrate antigens CA 50 and CA 242, and 1H NMR spectra of plasma were determined in a series of 51 patients, of whom 25 had malignant and 26 benign hepatopancreatobiliary disorder. The measurements in 1H NMR spectra were performed both manually and by computed technique, and both methylene (CH2) and methyl (CH3) peaks were evaluated. In the patients with pancreatic cancer (n = 17, including two cases of cancer of the papilla of Vater), the mean serum values of all tumour markers were significantly (p = 0.001) higher than in the patients with benign disease. The diagnostic sensitivity of the tumour markers alone reached 82-100% with a specificity of 35-82%. In the 1H NMR spectra of sera, the mean linewidth of the CH3-peak both in the manual and computed measurement was significantly narrower in the patients with pancreatic cancer than in the benign disease group. Using the cut-off level of 33 Hz, the sensitivity and specificity of 1H NMR alone was in the manual measurement 53% and 76%, respectively, while in the computed measurement the corresponding figures were 94% and 20%. When the serum tumour markers and 1H NMR spectroscopy were evaluated as combinations, both in the manual and computed measurements the specificities and positive likelihood ratios were clearly better than those of the tumour markers alone, but efficiencies improved only slightly. The results suggest that the combined use of tumour marker tests and 1H NMR of plasma gives only slightly improved accuracy in the diagnosis of pancreatic cancer.
Asunto(s)
Antígenos de Carbohidratos Asociados a Tumores/sangre , Biomarcadores de Tumor/sangre , Antígeno Carcinoembrionario/sangre , Espectroscopía de Resonancia Magnética , Neoplasias Pancreáticas/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Colestasis/sangre , Femenino , Humanos , Ictericia/sangre , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/sangre , Estudios Prospectivos , Curva ROC , Sensibilidad y EspecificidadRESUMEN
The serum values of the tumour markers carcinoembryonic antigen (CEA), cancer-associated carboanhydrate antigens CA 50 and CA 242 were evaluated in 193 patients with hepatopancreato-biliary diseases by receiver operating characteristic (ROC) curve analysis in order to compare their diagnostic accuracy in pancreatic cancer (n = 26), and to define optimal cut-off levels for the serum values of these tumour markers in the diagnosis of pancreatic cancer. The ROC analysis showed that all marker tests are considerably sensitive (77-81%) at the specificity level of 80%. The CA 242 test was more sensitive than CEA and CA 50 at high specificity levels (> 0.90) but slightly less sensitive at low specificity levels (< 0.60). The CEA test and CA 50 test performed equally well at high and low specificity levels. According to this study, it would seem optimal to use the cut-off level of 4.1 ng ml-1 for CEA, and the level of 137 U ml-1 for CA 50, since they gave a sensitivity of 77% at the specificity levels of 83% and 84%, respectively. For CA 242 the optimal cut-off level was 21 U ml-1, which gave a sensitivity and specificity of 81%. In conclusion, the results of ROC curve analysis suggest that the CA 242 test has an advantage over CEA and CA 50 because of its higher specificity in pancreatic cancer. In addition, it would seem reasonable to use higher cut-off values than what has been recommended for CEA and CA 50 in the diagnosis of pancreatic cancer, but for CA 242 the recommended cut-off level of 20 U ml-1 seems appropriate.
Asunto(s)
Biomarcadores de Tumor/sangre , Neoplasias Pancreáticas/inmunología , Curva ROC , Antígenos de Carbohidratos Asociados a Tumores/sangre , Antígeno Carcinoembrionario/sangre , Colestasis/diagnóstico , Colestasis/inmunología , Enfermedad Crónica , Humanos , Ictericia/diagnóstico , Ictericia/inmunología , Neoplasias Pancreáticas/diagnóstico , Pancreatitis/diagnóstico , Pancreatitis/inmunología , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To assess the accuracy of ultrasonography (US), computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) in distinguishing between benign and malignant causes of jaundice and cholestasis without jaundice. DESIGN: Prospective study. SETTING: University Hospital in Finland. SUBJECTS: A consecutive series of patients with jaundice (n = 187) or cholestasis without jaundice (n = 33). MAIN OUTCOME MEASURES: Correlation between diagnosis on imaging and final diagnosis at follow up 6 months later. Final diagnoses made on histology (n = 79), cytology (n = 5), operative or endoscopic findings (n = 96), and clinical course or serology (n = 40). RESULTS: The most common benign disease was choledocholithiasis (n = 83) and the most common malignant disease was carcinoma of pancreas (n = 33). The benign nature of the extrahepatic obstruction was correctly defined by US, CT, and ERCP in 53%, 53%, and 90% of patients, respectively, and the corresponding figures for choledocholithiasis were 22%, 25%, and 79% (ERCP compared with each of the other techniques, p < 0.0001). Intrahepatic benign diseases were diagnosed by US and CT in a third of cases. Malignant extrahepatic obstruction was correctly diagnosed in 57%, 80%, and 83%, respectively and the corresponding figures for pancreatic cancer were 60%, 97%, and 89% (US compared with CT, p < 0.01, and with ERCP, p < 0.05). Intrahepatic malignant lesions were diagnosed by US, CT, and ERCP in 100%, 77%, and 60% of patients, respectively. CONCLUSIONS: When the obstruction was benign and extrahepatic ERCP was the most accurate, but when it was malignant CT was comparable. Intrahepatic disease was best diagnosed by US and CT. The results emphasise that the three methods of imaging are complementary.
Asunto(s)
Colangiopancreatografia Retrógrada Endoscópica , Colestasis/diagnóstico , Colestasis/etiología , Ictericia/diagnóstico , Ictericia/etiología , Tomografía Computarizada por Rayos X , Adenoma de los Conductos Biliares/complicaciones , Adenoma de los Conductos Biliares/diagnóstico , Adenoma de los Conductos Biliares/diagnóstico por imagen , Neoplasias de los Conductos Biliares/complicaciones , Neoplasias de los Conductos Biliares/diagnóstico , Neoplasias de los Conductos Biliares/diagnóstico por imagen , Colestasis/diagnóstico por imagen , Colestasis Extrahepática/diagnóstico , Colestasis Extrahepática/diagnóstico por imagen , Colestasis Extrahepática/etiología , Diagnóstico Diferencial , Humanos , Ictericia/diagnóstico por imagen , Neoplasias Pancreáticas/complicaciones , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/diagnóstico por imagen , Estudios Prospectivos , Sensibilidad y Especificidad , UltrasonografíaRESUMEN
The sera of 51 patients with malignant (n = 25) and benign (n = 26) hepatopancreatobiliary disorders were analysed by 1H magnetic resonance spectroscopy (NMR) in order to distinguish between malignant and benign diseases causing jaundice and/or cholestasis. Macromolecular linewidths were determined both manually and automatically with a computed analysis, and both methylene (CH2) and methyl (CH3) resonances were evaluated. The mean linewidth of the CH3 peak was significantly narrower in the patients with malignant disease than in the patients with benign disease both in the manual and computed analyses, but no significant differences in the CH2 peak were detected. Diagnostic sensitivity and specificity of the CH3 peak determined in the computed analysis were 92% and 27% respectively. In the light of the current study, it seems obvious that because overlap between benign and malignant groups was too great, 1H NMR spectroscopy of plasma is not of practical value in distinguishing between benign and malignant causes of jaundice and/or cholestasis.
Asunto(s)
Biomarcadores de Tumor/sangre , Colestasis/etiología , Ictericia/etiología , Hepatopatías/diagnóstico , Espectroscopía de Resonancia Magnética , Enfermedades Pancreáticas/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bilirrubina/sangre , Proteínas Sanguíneas/análisis , Femenino , Humanos , Hepatopatías/complicaciones , Sustancias Macromoleculares , Masculino , Persona de Mediana Edad , Enfermedades Pancreáticas/complicaciones , Sensibilidad y Especificidad , Triglicéridos/sangreRESUMEN
Primary lymphoma of the pancreas is an extremely rare condition. There are no previous reports from northern Europe. It is important to differentiate pancreatic carcinoma from lymphoma because there is significant difference between the prognosis and treatment. We describe here a case of primary pancreatic lymphoma in a 64-year-old woman who was admitted to hospital because of a sudden abdominal pain and vomiting. Ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography findings are presented, and the features of pancreatic lymphoma in these imaging studies are discussed.
Asunto(s)
Linfoma de Células B/patología , Linfoma de Células B Grandes Difuso/patología , Linfoma no Hodgkin/patología , Neoplasias Pancreáticas/patología , Diagnóstico Diferencial , Femenino , Humanos , Linfoma de Células B/terapia , Linfoma de Células B Grandes Difuso/terapia , Linfoma no Hodgkin/terapia , Persona de Mediana Edad , Neoplasias Pancreáticas/terapiaRESUMEN
The diagnostic accuracy of ultrasound (US), computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), and tumour markers CEA, CA 50 and CA 242 in pancreatic cancer (n = 26) was studied in 113 patients with jaundice, in 20 patients with unjaundiced cholestasis, and in 60 patients with the suspicion of chronic pancreatitis or a pancreatic tumour. The sensitivities of US, CT and ERCP were 61.9%, 95.2% and 82.3%, the specificities 93.9%, 92.9% and 94.1%, and the efficiencies 91.6%, 96.6% and 92.1%, respectively. The sensitivities of CEA, CA 50 and CA 242 were 92.3%, 96.1% and 61.5%, the specificities 59.2%, 58.0% and 95.2%, and the efficiencies 63.7%, 63.2% and 90.6% respectively. The combined use of the imaging methods and tumour markers was also analysed. When either the imaging method or the serum marker test was required to be positive, the sensitivities of the combinations were clearly better than those of US and CA 242 alone, but only slightly better than those of CT, ERCP or the tumour markers CEA and CA 50 alone. When both the imaging test and the marker test were required to be positive, the specificities of the combinations were clearly better than those of CEA and CA 50 alone, but they did not exceed the specificity of the imaging methods or CA 242 alone. We conclude that CT, ERCP and CEA and CA 50 are highly sensitive in the diagnosis of pancreatic cancer in symptomatic patients, while the sensitivity of US and CA 242 is lower. The specificity of the imaging methods and CA 242 is high, but that of CEA and CA 50 is low. Imaging methods and serum tumour markers could be more used in clinical practice in a complementary manner. In patients with jaundice and/or cholestasis or with a suspicion of pancreatic tumour or chronic pancreatitis, the combined use may yield higher sensitivity than US alone and higher specificity than CEA or CA 50 alone.
Asunto(s)
Biomarcadores de Tumor/sangre , Neoplasias Pancreáticas/diagnóstico , Antígenos de Carbohidratos Asociados a Tumores/sangre , Antígeno Carcinoembrionario/sangre , Colangiopancreatografia Retrógrada Endoscópica , Colestasis/sangre , Colestasis/complicaciones , Reacciones Falso Negativas , Reacciones Falso Positivas , Humanos , Ictericia/sangre , Ictericia/complicaciones , Neoplasias Pancreáticas/sangre , Neoplasias Pancreáticas/diagnóstico por imagen , Estudios Prospectivos , Tomografía Computarizada por Rayos XRESUMEN
A prospective study of 113 patients with jaundice and 20 patients with unjaundiced cholestasis was carried out to evaluate the value of serum tumour markers, carcinoembryonic antigen (CEA) and monoclonal antibodies CA 50 and CA 242, in the distinction between benign and malignant diseases causing jaundice and/or cholestasis. In the patients with malignant disease (n = 37) the serum values of all tumour markers were significantly higher than in the patients with benign disease (n = 96). The sensitivities of CEA, CA 50 and CA 242 in detecting malignancy were 70.2%, 94.5% and 56.7%, respectively, while the specificities were 57.2%, 33.3% and 77.0%, respectively. Serum alkaline phosphatase and bilirubin levels had a high positive correlation with CA 50, and CA 242 correlated positively with serum bilirubin levels. No correlation was seen between CEA and alkaline phosphatase or bilirubin levels. The CEA, CA 50 and CA 242 tests may be used as useful complements to other investigative methods in the distinction between benign and malignant causes of jaundice and/or cholestasis. In particular, the rather high specificity of the CA 242 test for malignant diseases seems promising.
Asunto(s)
Adenoma de los Conductos Biliares/diagnóstico , Antígenos de Carbohidratos Asociados a Tumores/sangre , Neoplasias de los Conductos Biliares/diagnóstico , Biomarcadores de Tumor/sangre , Antígeno Carcinoembrionario/sangre , Colestasis/sangre , Cálculos Biliares/diagnóstico , Ictericia/sangre , Hepatopatías/diagnóstico , Neoplasias Hepáticas/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Pancreatitis/diagnóstico , Enfermedad Aguda , Adenoma de los Conductos Biliares/sangre , Fosfatasa Alcalina/sangre , Neoplasias de los Conductos Biliares/sangre , Bilirrubina/sangre , Colestasis/etiología , Diagnóstico Diferencial , Cálculos Biliares/sangre , Humanos , Ictericia/etiología , Hepatopatías/sangre , Neoplasias Hepáticas/sangre , Neoplasias Pancreáticas/sangre , Pancreatitis/sangre , Estudios ProspectivosRESUMEN
We studied the reliability of the clinical assessment and the discriminatory value of different symptoms and signs in diagnosing obstructive and non-obstructive diseases causing icterus and/or cholestasis. During a period of two-and-a-half years, clinical assessment done by both physicians-in-training and by senior physicians was completed for 266 patients, and the usefulness of different symptoms and signs was tested in 220 of these. Clinical assessment was found to be a reliable method in distinguishing between obstructive and non-obstructive conditions causing icterus, with the sensitivity of 92% and specificity of 86%. In cases of anicteric cholestasis, the sensitivity and specificity of clinical assessment were 74% and 80%, respectively. Abdominal pain and abdominal tenderness were significantly (p less than 0.01) associated with obstructive diseases, whereas an enlarged liver, fever and excessive consumption of alcohol were associated with non-obstructive diseases (p less than 0.01, p less than 0.05, p less than 0.05, respectively). Itching, vomiting, intolerance to fatty foods, previous cholecystectomy, abdominal tumour and clinical icterus had no discriminatory value. Clinical evaluation is a reliable method in the diagnostic workup of a patient with icterus or anicteric cholestasis, and it is still of crucial importance in directing further investigations.
Asunto(s)
Colestasis/diagnóstico , Ictericia/diagnóstico , Colestasis/etiología , Colestasis Extrahepática/diagnóstico , Colestasis Intrahepática/diagnóstico , Diagnóstico Diferencial , Humanos , Ictericia/etiología , Anamnesis , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
The aim of this study was to evaluate the new monoclonal tumour marker CA 242 in the diagnosis of pancreatic carcinoma and to compare it with the established markers CA 50 and CEA. Serum concentrations were determined in 113 patients with jaundice, in 20 patients with laboratory values suggesting cholestasis, and in 60 patients with a suspicion to have chronic pancreatitis. Twenty-four of these 193 patients had pancreatic carcinoma and two patients had carcinoma of papilla of Vater. The sensitivities of CA 242, CA 50 and CEA were 80.7%, 96.1%, and 92.3%, respectively. The specificities were 79.0%, 58.0%, and 59.2%. The sensitivities of combinations of CA 50 and CEA with CA 242 did not exceed the sensitivity of CA 50 alone. The specificity of CA 242 was improved by combining it with CEA (92.2%). The serum marker CA 242 seems to be less sensitive than CEA and CA 50 in the detection of pancreatic carcinoma, but it may prove useful because of its high specificity.
Asunto(s)
Antígenos de Carbohidratos Asociados a Tumores/sangre , Biomarcadores de Tumor/sangre , Neoplasias Pancreáticas/sangre , Adenoma de los Conductos Biliares/sangre , Antígenos de Neoplasias/sangre , Neoplasias de los Conductos Biliares/sangre , Enfermedades de las Vías Biliares/sangre , Neoplasias del Sistema Biliar/sangre , Antígeno Carcinoembrionario/sangre , Neoplasias de la Vesícula Biliar/sangre , Humanos , Hepatopatías/sangre , Enfermedades Pancreáticas/sangre , Neoplasias Pancreáticas/diagnósticoRESUMEN
The purpose of this prospective study was to investigate the diagnostic accuracy of ultrasound (US), computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) in the distinction between extrahepatic and intrahepatic causes of jaundice. The limit for the inclusion to the study was defined as a serum bilirubin concentration greater than or equal to 40 mumol/l. Altogether 187 jaundiced patients were studied. The sensitivities of US, CT, and ERCP were 63%, 77%, and 87%, respectively. The differences between all these methods were statistically significant. The specificities and positive predictive values were high, reaching 96-99%, but the negative predictive values were low, ranging between 38% and 60%. Choledochal stone disease constituted the main etiology of false-negative studies in all investigations. Imaging procedures have a prominent role in the diagnostic study of the jaundiced patient, but it is obvious that their diagnostic accuracy may vary between institutions because of the variance in local experience and expertise, and because of the differences in diseases causing jaundice.