Mackie C R, Dhorajiwala J, Blackstone M O, Bowie J, Moossa A R
Lancet. 1979 Aug 25;2(8139):385-9. doi: 10.1016/s0140-6736(79)90403-3.
An assessment was made of the diagnostic value of six tests done on 28 patients who proved to have resectable and 45 patients who had non-resectable pancreatic cancer. Ultrasonography and endoscopic retrograde cholangiopancreatography (ERCP) were the most sensitive tests for the diagnosis of resectable tumours. Ultrasonography was slightly, and cytology definitely, better for the diagnosis of resectable tumours than for the diagnosis of non-resectable tumours. Computerised tomography, angiography, and scintigraphy were not effective means of diagnosing resectable tumours. The differences in diagnostic sensitivities of the tests for resectable and non-resectable disease are probably due to variations in pathological features which influence not only the stage of presentation, but also the detectability of the tumour. As long as investigation is limited to patients with symptoms, a large proportion of tumours will not be diagnosed at a resectable stage. However, the results of this study suggest that the resectability rate may be maximised by the early use of ultrasonography in patients with symptoms suggesting cancer in the region of the head of the pancreas, and in patients with vague, non-specific complaints. A combination of ERCP and direct ductal aspiration for cytology is the best means of diagnosing resectable tumours.
对28例经证实为可切除胰腺癌的患者和45例不可切除胰腺癌的患者进行了六项检查，评估了这些检查的诊断价值。超声检查和内镜逆行胰胆管造影（ERCP）是诊断可切除肿瘤最敏感的检查方法。超声检查对可切除肿瘤的诊断略优于不可切除肿瘤，而细胞学检查对可切除肿瘤的诊断明显优于不可切除肿瘤。计算机断层扫描、血管造影和闪烁扫描不是诊断可切除肿瘤的有效手段。可切除和不可切除疾病检查的诊断敏感性差异可能是由于病理特征的差异，这些差异不仅影响疾病的表现阶段，还影响肿瘤的可检测性。只要检查仅限于有症状的患者，很大一部分肿瘤在可切除阶段将无法被诊断出来。然而，本研究结果表明，对于有胰腺头部区域癌症症状的患者以及有模糊、非特异性主诉的患者，早期使用超声检查可能会使可切除率最大化。ERCP和直接导管抽吸细胞学检查相结合是诊断可切除肿瘤的最佳方法。
