Fitzgerald P J, Fortner J G, Watson R C, Schwartz M K, Sherlock P, Benua R S, Cubilla A L, Schottenfeld D, Miller D, Winawer S J, Lightdale C J, Leidner S D, Nisselbaum J S, Menendez-Botet C J, Poleski M H
Cancer. 1978 Mar;41(3):868-79. doi: 10.1002/1097-0142(197803)41:3<868::aid-cncr2820410314>3.0.co;2-0.
By contract with the National Cancer Institute, the accuracy of diagnostic techniques was assessed in 184 patients suspected of having pancreas cancer. Of 138 patients who were operated upon, 89 were found to have pancreas duct cancer, 30 had cancer of a different site of origin in the head of the pancreas region and in 19 there was no evidence of cancer at operation. All of the 46 patients who were not operated upon, 13 proven to have cancer and 33 patients discharged as free of cancer, were followed in our clinic. The majority of our patients presented with signs and symptoms of biliary obstruction. Computerized transaxial tomography (CTT) gave a "correct" diagnosis in 31 of 33 patients (94%) with proven cancer, there were 2 patients with a false negative report and a false positive diagnosis occurred in 8 of 20 patients (40%) without cancer. Celiac angiography (CA) gave a correct diagnosis in 78 of 94 patients (83%) with cancer, a false negative in 17%, and a false positive in 32%. 76Selenomethionine pancreas scan correctly diagnosed 27 of 36 patients (75%) with cancer, gave a false negative in 25% and a false positive in 31%. Ultrasonography gave a correct diagnosis in 18 of 27 patients with cancer (67%), a false negative in 33% and a false positive in 28%. Endoscopic retrograde cholangiopancreatography diagnosed correctly 8 of 11 cases (73%) of cancer, there were false negative diagnoses in 3 cases (27%) and false positives in 3 of 14 patients (21%). Duodenal aspiration techniques gave a very low percentage of correct diagnoses. Chronic pancreatitis most commonly gave rise to a false positive diagnosis. Serum alkaline phosphatase was elevated in 82% of patients, gave 18% false negatives and 33% false positives. Carcinoembryonic antigen (CEA) was elevated (greater than 2.5 ng/ml) in most of the pancreas cancer patients but also in patients with other cancers and with non-cancerous diseases. In our hands, CTT, CA, alkaline phosphatase, 75Se-methionine and ultrasonography, in descending order, have given the highest percentage of correct diagnoses but false positive and false negative diagnoses prevented any single test from being conclusive.
根据与美国国立癌症研究所签订的合同，对184例疑似胰腺癌患者的诊断技术准确性进行了评估。在接受手术的138例患者中，89例被发现患有胰腺导管癌，30例在胰腺头部区域有其他原发部位的癌症，19例在手术中未发现癌症迹象。未接受手术的46例患者，其中13例被证实患有癌症，33例被诊断为无癌出院，均在我们诊所进行了随访。我们的大多数患者表现出胆道梗阻的体征和症状。计算机断层扫描（CTT）在33例经证实患有癌症的患者中有31例（94%）做出了“正确”诊断，2例出现假阴性报告，在20例无癌患者中有8例（40%）出现假阳性诊断。腹腔动脉造影（CA）在94例癌症患者中有78例（83%）做出了正确诊断，17%为假阴性，32%为假阳性。76硒蛋氨酸胰腺扫描在36例癌症患者中有27例（75%）做出了正确诊断，25%为假阴性，31%为假阳性。超声检查在27例癌症患者中有18例（67%）做出了正确诊断，33%为假阴性，28%为假阳性。内镜逆行胰胆管造影在11例癌症病例中有8例（73%）诊断正确，3例（27%）为假阴性诊断，在14例患者中有3例（21%）为假阳性。十二指肠抽吸技术的正确诊断率很低。慢性胰腺炎最常导致假阳性诊断。82%的患者血清碱性磷酸酶升高，18%为假阴性，33%为假阳性。大多数胰腺癌患者的癌胚抗原（CEA）升高（大于2.5 ng/ml），但其他癌症患者和非癌症疾病患者中也有升高。在我们的研究中，CTT、CA、碱性磷酸酶、75硒蛋氨酸和超声检查按诊断正确率从高到低排序，但假阳性和假阴性诊断使得任何单一检查都不能作为确诊依据。
