DiMagno E P, Malagelada J R, Taylor W F, Go V L
N Engl J Med. 1977 Oct 6;297(14):737-42. doi: 10.1056/NEJM197710062971401.
In 70 patients suspected of having pancreatic cancer, we prospectively compared results of seven diagnostic tests. Subsequent exploration (of 68) and liver biopsy (of two) demonstrated pancreatic cancer in 30, pancreatitis in seven, nonpancreatic neoplasms in nine and nonpancreatic non-neoplastic disease (or no disease) in 24. For detection of pancreatic disease, the best tests were the pancreatic-function test (cholecystokinin-stimulated enzyme outputs) and ultrasonography. The pancreatic scan was nonspecific (P less than 0.001), and thermography was insensitive (P less than 0.001). Endoscopic retrograde pancreatography and arteriography were significantly more sensitive than cytologic study in diagnosis of pancreatic cancer (P less than 0.001). Therefore, when pancreatic cancer is suspected, abdominal ultrasound should be performed first, and if it is negative, a pancreatic-function test next. A positive result from either test warrants an endoscopic retrograde pancreatography for definitive diagnosis. This sequence identified 88 per cent of patients without pancreatic disease and 89 per cent with pancreatic cancer.
在70例疑似胰腺癌患者中，我们前瞻性地比较了7种诊断检查的结果。随后的探查（68例）和肝活检（2例）显示，30例为胰腺癌，7例为胰腺炎，9例为非胰腺肿瘤，24例为非胰腺非肿瘤性疾病（或无疾病）。对于胰腺疾病的检测，最佳检查是胰腺功能试验（胆囊收缩素刺激的酶分泌量）和超声检查。胰腺扫描不具特异性（P<0.001），热成像检查不敏感（P<0.001）。在胰腺癌诊断中，内镜逆行胰胆管造影和动脉造影比细胞学检查明显更敏感（P<0.001）。因此，当怀疑胰腺癌时，应首先进行腹部超声检查，若结果为阴性，则接着进行胰腺功能试验。任何一项检查结果呈阳性都需要进行内镜逆行胰胆管造影以明确诊断。这一检查顺序可识别出88%无胰腺疾病的患者以及89%患有胰腺癌的患者。
