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The diagnostic dilemmas in discrimination between pancreatic carcinoma and chronic pancreatitis
Early diagnosis to distinguish between malignant pancreatic tumours and chronic pancreatitis is still difficult, despite significant progress in imaging techniques. Moreover, patients with chronic pancreatitis have a higher risk of pancreatic cancer development.
The study of
clearly confirms these difficulties, independently of rigorous selection criteria of patients with chronic pancreatitis. To exclude the possibility that chronic pancreatitis may be caused by early potentially premalignant lesions, the authors eliminated from their investigations even patients with chronic pancreatitis in whom pancreatic cancer was recognized during the first two years of follow up.
Several studies indicate the value of circulating tumour marker evaluation as a simple, sensitive, and reliable test facilitating the differential diagnosis between chronic pancreatitis and cancer.1–7 To improve the effectiveness of serological diagnosis of patients with pancreatic carcinoma, different tumour markers have been assessed, including CEA, CA 242, CA 50, and CA 72-4.1–4,7 However, the sensitivity and specificity of these markers appeared to be insufficient for differentiation of pancreatic carcinoma from chronic pancreatitis. In 1996, CAM 17-15 was described as a new useful diagnostic marker in pancreatic carcinoma. It showed a sensitivity similar to that of CA 19-9 but higher specificity, giving only 10% false positive results in patients with chronic pancreatitis.
Tissue polypeptide specific antigen (TPS) is a different type of antigen that does not correlate with tumour mass but reflects tumour proliferative activity.8 Our study6 revealed that elevated levels of TPS detected preoperatively 100% of patients with pancreatic carcinoma. The introduction of 200 U/l as a decision criterion for TPS level allowed an increase in the specificity of this marker to 98% and eliminated all but 2% of the false positive results in patients with chronic pancreatitis. Moreover, TPS is useful for detection of the early stages of clinical advancement of pancreatic carcinoma.
It seems that measurement of TPS, using 200 U/l as the cut off value, should facilitate more precise discrimination between the early stages of pancreatic carcinoma and chronic pancreatitis.
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