Diagnosis of Pancreatic Carcinoma: Imaging Techniques and Tumor Markers
Diagnosis of Pancreatic Carcinoma: Imaging Techniques and Tumor Markers
复制标题
胰腺癌的诊断：影像技术和肿瘤标志物
作者：
C. Niederau;J. Grendell
鉴于新的成像技术和血清肿瘤标志物的数量不断增加，目前尚不清楚哪种组合或哪种顺序的检测可以为胰腺癌的诊断提供最多的信息。本综述确定了各种检查的诊断价值，并评估了哪些检查组合可以提供最多的信息，以及哪些可能被认为是目前诊断胰腺癌的合理方法。在目前的分析中，内窥镜逆行胆血管造影（ERCP）提供了92%的灵敏度，分别超过了计算机断层扫描（CT）和超声计算的83%和74%的灵敏度。三种成像技术的特异性均超过90%。血清检测CA 19-9的灵敏度为83%，大大高于癌胚抗原和其他各种肿瘤标志物的敏感性。CA 19-9与超声联合使用可使单独进行的各项检查的灵敏度提高10-15%。细针活检诊断胰腺癌的敏感性为83%，特异性几乎为99%。在这些资料的基础上，建议在怀疑胰腺癌时，超声结合ca19 - 9检测作为初步检查。如果超声不确定或与临床评价不一致，以及超声阴性但CA 19-9异常的患者也必须进行CT检查。CT、超声、CA 19-9阴性结果可排除多数患者的胰腺癌。超声或CT阳性结果通常导致细针活检，这有助于避免大多数诊断性剖腹手术。超声、CT和细针活检不能明确诊断的患者必须进行ERCP检查。在大多数胰腺癌患者中，超声和CT等非侵入性成像技术也允许适当的分期。然而，在一些患者中，可能需要进行腹腔镜和血管造影来制定进一步治疗的战略计划。尽管现代成像技术和血清肿瘤标志物可以诊断小至2-3厘米的胰腺癌，并有助于避免大多数诊断性剖腹手术，但诊断能力的提高尚未显著改善预后。
In view of the increasing number of new imaging techniques and serum tumor markers, it is not well established which combination or which order of tests may provide the most information for diagnosis of pancreatic carcinoma. This review determines the diagnostic value of the various tests and evaluates which combination of tests may provide the most information and what may be considered to be a current rational approach to the diagnosis of pancreatic carcinoma. In the present analysis endoscopic retrograde chol-angiopancreatography (ERCP) provided a 92% sensitivity that exceeded the 83% and 74% sensitivities calculated for computed tomography (CT) and ultrasound, respectively. The specificity of all three imaging techniques exceeded 90%. Serum determination of CA 19–9 yielded an 83% sensitivity, which was considerably higher than sensitivities of carcinoembryonic antigen and various other tumor markers. The combination of CA 19–9 and ultrasound improved the sensitivity of each test performed alone by 10–15%. Fine-needle biopsy allows diagnosis of pancreatic carcinoma with a sensitivity of 83% and an almost perfect specificity of 99%. On the basis of these data, the combination of ultrasound and determination of CA 19–9 is recommended as the initial tests when pancreatic carcinoma is suspected. CT also must be performed if ultrasound is indeterminant or inconsistent with the clinical evaluation, as well as in patients with negative ultrasound but abnormal CA 19–9. Negative results of CT, ultrasound, and CA 19–9 will exclude pancreatic carcinoma in most patients. A positive ultrasound or CT result usually leads to fine-needle biopsy, which helps avoid most diagnostic laparotomies. ERCP must be performed in patients where ultrasound, CT, and fine-needle biopsy do not clarify the diagnosis. In the majority of patients with pancreatic carcinoma, noninvasive imaging techniques such as ultrasound and CT also allow adequate staging. In some patients, however, laparoscopy and angiography may need to be performed for strategic planning of further therapy. Although modern imaging techniques and serum tumor markers allow diagnosis of pancreatic carcinomas as small as 2–3 cm and help avoid most diagnostic laparotomies, this improvement in diagnostic capability has as yet not significantly improved the prognosis.
DOI：
10.1016/s0021-9258(19)45389-1
发表时间：
1982-12
期刊：
The Journal of biological chemistry
影响因子：
--
作者：
John L. MagnaniS;Bo Nilssong;Manfred BrockhausSV;David Zopfl;Zenon SteplewskiJI;Hilary Koprowskill;V. Ginsburg
通讯作者：
John L. MagnaniS;Bo Nilssong;Manfred BrockhausSV;David Zopfl;Zenon SteplewskiJI;Hilary Koprowskill;V. Ginsburg
影响因子：
11.2
作者：
J. Magnani;Z. Steplewski;H. Koprowski;V. Ginsburg
通讯作者：
J. Magnani;Z. Steplewski;H. Koprowski;V. Ginsburg
影响因子：
15.9
作者：
BAST, RC;FEENEY, M;KNAPP, RC
通讯作者：
KNAPP, RC