DelMaschio A, Vanzulli A, Sironi S, Castrucci M, Mellone R, Staudacher C, Carlucci M, Zerbi A, Parolini D, Faravelli A
Department of Radiology, University Hospital, Milan, Italy.
Radiology. 1991 Jan;178(1):95-9. doi: 10.1148/radiology.178.1.1984331.
The authors prospectively performed serum CA 19-9 assessment, ultrasound (US), computed tomography (CT), and CT-guided fine-needle aspiration biopsy (FNAB) of the pancreas in 81 consecutive patients with suspected chronic pancreatitis or pancreatic neoplasm. The final diagnosis was pancreatic cancer in 54 patients and chronic pancreatitis in 27 patients. CA 19-9 assessment, US, CT, and FNAB were considered nondiagnostic, respectively, in 0%, 25%, 19%, and 6% of cases. When a definite diagnosis was rendered, the positive predictive value was 90% for CA 19-9 assessment, 95% for US, 98% for CT, and 100% for FNAB; the negative predictive value was, respectively, 69%, 95%, 86%, and 100%. The accuracy of all diagnostic and nondiagnostic studies was 81% for CA 19-9 assessment, 72% for US, 77% for CT, and 94% for FNAB. It is concluded that CT-guided pancreatic FNAB is the most reliable examination for enabling differential diagnosis of pancreatic cancer and chronic pancreatitis. When the pancreas is well visualized at US, the negative predictive value for pancreatic cancer is more accurate than that of CA 19-9 assessment and CT.
作者对81例连续的疑似慢性胰腺炎或胰腺肿瘤患者进行了前瞻性血清CA 19-9评估、超声（US）、计算机断层扫描（CT）以及CT引导下胰腺细针穿刺活检（FNAB）。最终诊断为胰腺癌54例，慢性胰腺炎27例。CA 19-9评估、US、CT和FNAB分别在0%、25%、19%和6%的病例中被认为无法诊断。当做出明确诊断时，CA 19-9评估的阳性预测值为90%，US为95%，CT为98%，FNAB为100%；阴性预测值分别为69%、95%、86%和100%。所有诊断性和非诊断性检查的准确率，CA 19-9评估为81%，US为72%，CT为77%，FNAB为94%。结论是CT引导下胰腺FNAB是鉴别胰腺癌和慢性胰腺炎最可靠的检查。当胰腺在US下显示良好时，胰腺癌的阴性预测值比CA 19-9评估和CT更准确。
