Diagnostic Efficiency Of Pet/ct Compared With Ca19
Cases in the malignant group had significantly higher CA19-9 than those in the benign group . The sensitivity, specificity, and accuracy of CA19-9 alone were 80.0, 69.0, and 74.9%, respectively.
Figure 4. Differences of CA19-9 between malignant and benign groups, ***P< 0.001 ROC curves of CA19-9 and SUVmax.
For the 358 cases which underwent both PET/CT and serum CA19-9 within 2 weeks , we compared their diagnostic efficiency by ROC curves. The areas under the curves of SUVmax and serum CA19-9 were 0.90 and 0.831, respectively, indicating that the diagnostic efficiency of SUVmax is higher than that of serum CA19-9. The best diagnostic performances were achieved when the optimal cut-offs were set at 3.75 for SUVmax and 105.35 for CA19-9 .
Diagnostic efficiencies were significantly improved when combined PET/CT with CA19-9 compared to PET/CT alone . Moreover, the high NPV of parallel test indicates that negative results of both CA19-9 and PET/CT decrease the odds of a malignant diagnosis. Similarly, positive results of both two tests increase malignance possibility with a PPV of 100.0% for serial test .
Table 4. Diagnostic efficiency of PET/CT compared with other tests.
Rationale For The Review
Pancreatic adenocarcinoma is fatal if untreated, so it is critical to choose the right imaging test and initiate therapy in a timely manner. A comparative effectiveness review on this topic can assist medical decisions in several ways. First, different imaging tests are believed to have utility in different circumstances and a clear delineation of the relevant evidence would help guide clinicians and patients in choosing the most appropriate imaging test. Second, the evidence may favor some tests over others and, if so, resources can be devoted to the better tests. Third, it is important to clarify the practice of using a second imaging test: delineating the circumstances under which to order a second test and which test to order and if a test is ordered, what is its influence on diagnosis, staging, survival, and quality of life. Fourth, the accuracy of any imaging test depends on the operators and readers skills and the environment in which the test is performed . Determining the extent to which this is important for various tests, can also help better guide clinicians and patients in the workup process. Fifth, harms are always a concern by estimating the actual rates of the various harms of different imaging tests, a CER can help discriminate reasonable fears from unreasonable ones.
Compare Diagnostic Efficiencies Of Other Combinations
CA19-9 could help improve the diagnostic efficiency combined with CECT or CEMR compared to the two imaging modalities alone. Given that sensitivity of CEMR is already pretty high, sensitivity of combined diagnosis was not significantly improved . Although combination of CECT and CEMR showed relatively higher sensitivity and specificity, it had no significant difference compared with CECT alone , which may due to limited cases in this group .
Table 6. Diagnostic efficiencies of other combinations.
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How Are Ultrasounds Used To Diagnose Pancreatic Cancer
Ultrasounds create images of the pancreas that can help doctors spot tumors. There are two types that are commonly used during the pancreatic cancer diagnostic process. If your doctor suspects you have pancreatic cancer, you might have one or both types performed.
- Abdominal ultrasound. An abdominal ultrasound can help doctors get a complete picture of your abdominal region. Its a good way to rule out other conditions that could be causing your symptoms, and it might be one of the first tests you have done. If no other conditions are spotted on this ultrasound, you might have a CT scan or an endoscopic ultrasound.
- Endoscopic ultrasound. During an endoscopic ultrasound, a thin tube called an endoscope is inserted through your mouth, down your esophagus, and directly into your stomach and intestines. This allows doctors to see your digestive tract up close and to collect tumor cell samples for a biopsy.
Both tests use ultrasound sound wave technology to create images of your pancreas and digestive tract. They allow doctors to look for tumors, inflammation, bile duct enlargement, and other signs of pancreatic cancer.
Neither test is enough on its own to diagnose pancreatic cancer. But the data they can provide is important and can help doctors plan the next steps.
Review Of Key Questions
For all EPC reviews, Key Questions were reviewed and refined as needed by the EPC with input from Key Informants and the Technical Expert Panel to ensure that the questions are specific and explicit about what information is being reviewed. In addition, the Key Questions were posted for public comment and finalized by the EPC after review of the comments.
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What Are The Reasons For A Ct Scan Of The Pancreas
A CT scan of the pancreas may be performed to assess the pancreas for tumors and other lesions, injuries, bleeding, infections, abscesses, unexplained abdominal pain, obstructions, or other conditions, particularly when another type of examination, such as X-rays or physical examination, is not conclusive.
CT scans of the pancreas may be used to distinguish between disorders of the pancreas and disorders of the retroperitoneum .
There may be other reasons for your doctor to recommend a CT scan of the pancreas.
What Happens During A Ct Scan
CT scans may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician’s practices.
Generally, a CT scan follows this process:
You may be asked to change into a patient gown. If so, a gown will be provided for you. A locked will be provided to secure all personal belongings. Please remove all piercings and leave all jewelry and valuables at home.
If you are to have a procedure done with contrast, an intravenous line will be started in the hand or arm for injection of the contrast media. For oral contrast, you will be given a liquid contrast preparation to swallow. In some situations, the contrast may be given rectally.
You will lie on a scan table that slides into a large, circular opening of the scanning machine. Pillows and straps may be used to prevent movement during the procedure.
The technologist will be in another room where the scanner controls are located. However, you will be in constant sight of the technologist through a window. Speakers inside the scanner will enable the technologist to communicate with and hear you. You may have a call button so that you can let the technologist know if you have any problems during the procedure. The technologist will be watching you at all times and will be in constant communication.
As the scanner begins to rotate around you, X-rays will pass through the body for short amounts of time. You will hear clicking sounds, which are normal.
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Whats An Ultrasound Procedure Like For Pancreatic Cancer
The procedure for an ultrasound depends on the type of ultrasound youre having. Both types are generally done as outpatient procedures, but an endoscopic ultrasound is slightly more complex. This is primarily because youll receive sedation during an endoscopic ultrasound to prevent any discomfort.
Read more about each procedure below.
Evolving Imaging Criteria For Tumor Resectability
CT is the modality of choice for the assessment of vascular invasion with a specificity of 82100% and sensitivity of 7096% . Biphasic pancreatic CT, performed with thin slice thickness and multi-planar reformatting, is the optimal technique to evaluate the peripancreatic arteries and veins during the pancreatic and portal venous phases, respectively . Axial, coronal, and sagittal reconstructions should be examined thoroughly to assess the tumor contact with the circumference and long axis of the vessels. Maximum intensity projections images and volume-rendered images are useful in detecting subtle changes in vascular calibers . MR imaging including MR angiography is an excellent alternative option with a sensitivity and specificity comparable to CT . EUS has a sensitivity of 72% and specificity 89% for the preoperative diagnosis of vascular invasion with a higher sensitivity and specificity when using a contrast material . However, EUS is not routinely recommended to assess vascular involvement due to variable hepatic arterial anatomy, high operator-dependence, and relative invasiveness .
Table 1 The defining criteria of borderline resectability according to the International Association of Pancreatology consensus Table 2 The defining criteria of tumor resectability according to the National Comprehensive Network guidelines and the International Association of Pancreatology consensus
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What Does Pancreatic Cancer Look Like On An Ultrasound
Only some parts of the pancreas are visible during an abdominal ultrasound. If signs of cancer, like a tumor mass or inflammation, are present in those sections, they might be visible in the images created by an abdominal ultrasound.
Tumors in other parts of the pancreas wont be visible with an abdominal ultrasound. But endoscope ultrasounds can better detect these tumors. Tumors will appear as masses on endoscopic images.
Endoscopic ultrasounds can also detect enlarged bile ducts.
Some People Might Not Need A Biopsy
Rarely, the doctor might not do a biopsy on someone who has a tumor in the pancreas if imaging tests show the tumor is very likely to be cancer and if it looks like surgery can remove all of it. Instead, the doctor will proceed with surgery, at which time the tumor cells can be looked at in the lab to confirm the diagnosis. During surgery, if the doctor finds that the cancer has spread too far to be removed completely, only a sample of the cancer may be removed to confirm the diagnosis, and the rest of the planned operation will be stopped.
If treatment is planned before surgery, a biopsy is needed first to be sure of the diagnosis.
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Are There Yearly Recommended Screening Tests For Pancreatic Cancer
Currently, there are no recommended yearly screening tests for pancreatic cancer. There are a few tests available to people who are at high risk for pancreatic cancer, but these tests arent covered by insurance companies or available to people who arent considered high risk.
Researchers are working to develop additional tests, and standard screenings might be available in the future.
How Is Pancreatic Cancer Diagnosed And Evaluated
Patients often have some symptoms that prompt a visit to the doctor, such as severe abdominal pain extending to the back, nausea, vomiting, jaundice or unexplained weight loss.
To help determine if you have pancreatic cancer and if it has spread, your doctor may order one or more of the following tests.
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Abdominal Ultrasound For Pancreatic Cancer Procedure
An abdominal ultrasound generally takes less than an hour, and you dont need to take any special steps before your appointment. Youll be able to drive yourself to and from your ultrasound, and you can plan on returning to work or resuming any other standard daily activities.
At your appointment, youll be asked to change into a patient gown and remove any jewelry. Youll lie on an examination table during the procedure, and gel will be applied to your abdomen. This gel is safe and wont stain.
The ultrasound technician will use a device called a transducer against your stomach. This sends sound waves through your body and creates images. An ultrasound is generally painless.
You should have your results back as soon as a doctor reads and interprets the images. The exact timeframe for this can vary, but it shouldnt be more than a week. You can ask the ultrasound technologist if they can estimate how long it might take before you receive your results.
When Pancreatic Cancer Is Suspected A Ct Scan Is The First Imaging Study Done
There are three types of CT scan for pancreatic cancer detection.
Pancreatic cancer is one of the most vicious cancers because by the time symptoms start presenting, the disease is in an advanced state making prognosis very grim.
Furthermore theres no way to screen for this disease, which takes out about 36,000 Americans every year.
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Background And Objectives For The Systematic Review
Pancreatic cancer is the fourth most common cause of cancer death among men and women in the United States.1,2 In 2013, about 45,000 people in the United States will receive a diagnosis of pancreatic cancer, and 38,000 will die of the disease.3 The median age at diagnosis is 71 years, the overall 5-year survival is 5.8 percent, and the overall age-adjusted mortality rate is 10.8 per 100,000 people per year.4,5 The most common type of pancreatic cancer is adenocarcinoma .2 Based on rates from 2007 to 2009, the lifetime risk of receiving a diagnosis of pancreatic cancer is 1.47 percent.5
Risk factors for pancreatic cancer include tobacco use a personal history of pancreatitis, diabetes, or obesity and a family history of pancreatic cancer.1 About 10 percent of patients with pancreatic cancer have a positive family history for the disease.4 Pancreatic cancer incidence rates were reportedly highest among African-American men and women during 2004 and 2008.1 The second highest rates were reported for white men and women .1 The differences between these populations and burden of disease may be related to higher rates of cigarette smoking and diabetes mellitus among African-American men versus white men and higher body mass indices among African-American women versus white women.1
Effectiveness Of Ct Scan For Pancreatic Cancer Detection
A CT scan is able to detect pancreatic cancers that are two cm or greater, in about 90 percent of the cases, says Jordan Winter, MD, a hepato-pancreatic-biliary and oncology surgeon and Chief of the Division of Surgical Oncology at University Hospitals Cleveland Medical Center.
It is the best available test for assessing pancreatic cancer, adds Dr. Winter.
It is best performed with IV contrast to delineate nearby blood vessels.
But in some cases, non-contrast CT is used.
The non-contrast is done on people who have compromised kidney function or who are allergic to the dye.
Using the dye is very important because it enables visualization of the tumor.
A CT scan without the contrast dye will yield poor sensitivity for pancreatic cancer masses.
No contrast material also means poor specificity for these masses.
CT with intravenous contrast. The dye is used with a multidetector CT , which provides high resolution and very thin slices or cross-sections of the patients abdomen.
MDCT, then, generates good visualization of an adenocarcinoma good enough to assist with early detection of pancreatic cancer and even staging of the mass .
Due to its level of effectiveness, the multidetector CT scan with dye is the imaging study of choice for the preliminary diagnostics of a patient whos suspicious for pancreatic cancer unless, of course, they have kidney failure or a history of allergic reaction to the dye.
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Grading The Strength Of Evidence For Individual Comparisons And Outcomes
We will use the EPC system for grading evidence on diagnostic tests as described in the EPC guidance chapter by Singh et al.42 This system uses up to eight domains as input . The output is a rating of the strength of evidence: high, moderate, low, or insufficient. This rating is made separately for each outcome of each comparison of each KQ.
A rating of insufficient will be given when the evidence does not permit a conclusion for the outcome of interest for that KQ. For single-test accuracy, this means whether the evidence permits an estimate of the sensitivity and specificity of the test. For comparative test accuracy, it means whether the evidence permits a conclusion that either evidence indicates that test A is more accurate, evidence indicates that test B is more accuracy, or 3) evidence indicates that tests A and B are similarly accurate. If none of these conclusions can be drawn, then evidence is deemed insufficient for questions on comparative test accuracy.
If the evidence is sufficient to permit a conclusion, then the rating is deemed high, moderate, or low. The rating will be provided by two independent raters, and discrepancies will be resolved by consensus. Below, we discuss the eight domains and how they will be considered as input to the rating:
Risk of bias . If the evidence permits a conclusion, and all else being equal, a set of studies at low risk of bias yield a higher strength of evidence rating than a set of studies at moderate or high risk of bias.
Imaging Preoperatively For Pancreatic Adenocarcinoma
Jason Alan Pietryga, Desiree E. Morgan
Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35233, USA
Correspondence to:
Keywords: Pancreatic cancer staging multi-detector computed tomography magnetic resonance imaging
Submitted Dec 17, 2014. Accepted for publication Jan 22, 2015.
doi: 10.3978/j.issn.2078-6891.2015.024
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Genetic Counseling And Testing
If youâve been diagnosed with pancreatic cancer, your doctor might suggest speaking with a genetic counselor to determine if you could benefit from genetic testing.
Some people with pancreatic cancer have gene mutations in all the cells of their body, which put them at increased risk for pancreatic cancer . Testing for these gene mutations can sometimes affect which treatments might be helpful. It might also affect whether other family members should consider genetic counseling and testing as well.
For more information on genetic testing, see Genetics and Cancer.
How Is Pancreatic Cancer Treated
Pancreatic cancer is usually treated with a combination of surgery, radiation and chemotherapy. The type of treatment depends on the stage of the cancer or how far it has spread. Your physician will help you weigh the treatment options as they relate to your age, overall health and your personal preferences.
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