We assessed the value of several serologic markers in detecting pancreatic carcinoma in a prospective study of 270 patients. The sensitivity and specificity of galactosyltransferase isoenzyme II (GT-II), carcinoembryonic antigen (CEA), alpha-feto protein, ferritin, C1q binding, and ribonuclease were determined. GT-II was the most sensitive (67.2 per cent) and specific (98.2 per cent) for discriminating between benign and malignant disease and was more sensitive and specific than CEA, the next most useful marker. Sensitivity was 64 per cent for ultrasound, 79.4 per cent for computerized body tomography (CBT), and 92.8 per cent for endoscopic retrograde cholangiopancreatography (ERCP). As a single test, only ERCP was more sensitive than GT-II, but more sensitive diagnoses resulted when GT-II was combined with ultrasound (92 per cent), CBT (88 per cent), or ERCP (100 per cent). Serum GT-II may be useful both by itself and in combination with imaging techniques in distinguishing benign from malignant pancreatic disease; however, this test does not discriminate between pancreatic carcinoma and other gastrointestinal neoplasms. (N Engl J Med. 1981; 304:1313–8.) THE incidence of pancreatic carcinoma has steadily increased in recent years,1 2 3 yet its diagnosis often remains difficult despite the availability of newer radiologic and endoscopic techniques.4 5 6 7 8 9 In the past, the various tests used to establish this preoperative diagnosis have included pancreatic-function tests,6,7,9,10 duodenal cytology,6,10 pancreatic scanning,5 6 7 8,11 and arteriography.5,7,12,13 More recently, abdominal ultrasound,5 6 7,11,14 15 16 computed body tomography (CBT),5 6 7 8,11,16 and endoscopic retrograde cholangio pancreatography (ERCP)5 6 7 8,16 17 18 19 have been used with greater frequency for investigating patients suspected of harboring a pancreatic tumor. However, no single test has proved to have both total sensitivity (calculated as the number of tests diagnosing pancreatic carcinoma divided by the. . .
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