Evaluation of imaging techniques and ca 19-9 in differential diagnosis of carcinoma and other focal lesions of pancreas

Abstract

BACKGROUND: Ultrasonography and magnetic resonance imaging are the most important imaging techniques in the diagnostics of pancreatic carcinoma and disease staging; they are also very useful in monitoring and follow-up of treatment efficacy. The problems with imaging diagnostics arise in certain cases of pancreatic focal lesions - for example in the differentiation of focal chronic pancreatitis and pancreatic carcinoma. Our objectives were the evaluation of ultrasonography and magnetic resonance imaging reliability and determination of the importance of tumor antigen CA 19-9 in the diagnostics of pancreatic carcinoma. METHODS: Our investigation included patients with pancreatic focal mass suspected of malignancy. All patients were examined by ultrasonography, MR, and ultrasound-guided needle biopsy. Cytopathologic examination of biopsied samples was used to diagnose the disease. Oncomarker levels CA 19-9 were assayed in all patients. RESULTS: Magnetic resonance imaging and ultrasonography examination made possible the correct diagnosis of carcinoma in case of 17 patients; in three patients with focal chronic pancreatitis the diagnosis was false positive. No case of false-negative diagnosis was found. The tumor antigen CA 19-9 in serum was determined and it was clearly positive (above 45U/ml) in all patients (17) with pancreatic cancer. CONCLUSION: Imaging techniques gave good results in the evaluation of pancreatic pathology. However, when using imaging techniques differential diagnosis between focal chronic pancreatitis and pancreatic carcinoma seems to be major problem. Correlation of imaging technique and determination of tumor antigen CA 19-9 has an important role in the diagnostics of pancreatic carcinoma. Imaging techniques and identification of tumor antigen CA 19-9 are complementary methods in the examination and diagnostics of pancreatic carcinoma and they allow better precision of diagnosis of pancreatic focal lesions.