Mackie C R, Cooper M J, Lewis M H, Moossa A R
Ann Surg. 1979 Apr;189(4):480-7.
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.
186名因疑似胰腺癌接受检查的患者中，有85人最终明确诊断为胰腺癌（58例）或慢性胰腺炎（27例）。他们接受了前瞻性研究，使用了超声检查、计算机断层扫描、放射性核素扫描、内镜逆行胰胆管造影（ERCP）、选择性腹腔动脉和肠系膜上动脉造影、十二指肠引流研究、细胞学研究、血清癌胚抗原检测和胰腺癌胚抗原检测。对结果进行比较，以确定在被认为患有胰腺癌或胰腺炎的患者中，哪种检查最常且可靠地区分这两种疾病。得出了解读结果的标准，首先是正确诊断率最高，其次是准确性最高。应用这些标准，超声检查的正确诊断率最高（97%的患者被诊断出，准确率为84%）。ERCP、十二指肠引流研究和细胞学检查是最准确的检查（每项检查的准确率均为86%），但基于这种准确性，ERCP最常给出诊断结果（诊断率：ERCP为70%，十二指肠引流为32%，细胞学为35%）。结果表明，超声检查是最佳的非侵入性检查，并且在单一程序中结合ERCP、胰液检测和细胞学检查可能被证明是最佳的鉴别性检查。
