Clinical usefulness of computer-assisted diagnosis using combination assay of tumor markers for pancreatic carcinoma

Abstract

Background. There has been extensive use of serum tumor markers in diagnosing pancreatic adenocarcinoma. There is no tumor marker, however, that alone has sufficient diagnostic accuracy. It is necessary to know which combination of tumor markers should be used to detect pancreatic cancer, with respect to clinical usefulness and cost effectiveness. Methods. Serum levels of 17 kinds of tumor markers were determined in 145 patients and 40 healthy volunteers. Thirty‐five patients with proven pancreatic adenocarcinoma, and 32 with benign pancreatobiliary disease (14 chronic pancreatitis and 18 biliary stones) were selected. For analysis of the usefulness of each tumor marker to differentiate these two groups, scatterplot and relative operating characteristic (ROC) analyses were used. A multivariate discriminant system to differentiate these two groups was developed using stepwise discriminant analysis by backward elimination selection. Results. The significance of each tumor marker varied according to the tumor volume. By ROC analysis, the markers were divided into four subgroups according to their usefulness in discriminating pancreatic adenocarcinoma from benign pancreatobiliary disease. A discriminant system consisting of two different discriminant functions using nine tumor markers (CA 19–9, DUPAN‐2, TPA, elastase‐1, lipase, amylase, γ‐glutamyl transpeptidase, alkaline phosphatase, and lactate dehydrogenase) was developed and designated CAMPAS‐P; it could differentiate between all 35 cases of pancreatic adenocarcinoma and 32 cases of benign pancreatobiliary disease. On the other hand, CAMPAS‐P showed a low positive rate in pancreatic tumors of unusual histologic type, and poor organ‐specific diagnostic ability in various digestive organ malignancies. Conclusions. CAMPAS‐P may be very useful for differential diagnosis between pancreatic adenocarcinoma and benign pancreatobiliary disease.

Evaluating the role of serum elastase 1 in the diagnosis of pancreatic cancer

“…Serum E1 had sensitivity of 61.5%, specificity of 75.3% and overall accuracy of 71.2% for the diagnosis of pancreatic cancer, which agreed with results reported by other authors 2,6,7,9 . In the meantime, the sensitivity, specificity and overall accuracy of CA19‐9 was 71.8%, 73.1% and 72.7%, respectively.…”

“…The normal value of serum E1 indicated by the assay kit is 4 ng/mL, and a range of 3–5 ng/mL is accommodated by most authors 2,4–6 . It could also be as high as 7.396 ng/mL 7 . The present study is the first, according to our knowledge, to establish the cutoff value of serum E1 in Chinese adults to be 4.36 ng/mL by the method of ROC curve.…”

“…In this study DA had better diagnostic effectiveness as compared with combined assay and the test of E1 and CA19‐9 alone in terms of overall accuracy. Our study indicated that assay of multiple tumor markers with implementation of appropriate statistical methods can improve the diagnostic level of pancreatic cancer, and this is important given the fact that there is no better single tumor marker available so far 6–9 …”

“…2,[4][5][6] It could also be as high as 7.396 ng/mL. 7 The present study is the first, according to our knowledge, to establish the cutoff value of serum E1 in Chinese adults to be 4.36 ng/mL by the method of ROC curve. Another statistical method employed in this study is DA.…”

Clinical utility of tumor markers in hepatocellular and pancreatic carcinomas

“…Saito et al19 developed a computer‐assisted multivariate analysis system to differentiate pancreatic cancer from benign pancreatobiliary disease. They demonstrated that, by scatterplot and relative operating characteristic analysis, a discriminant system consisting of two different discriminant functions, using nine tumor markers (CA19‐9, DUPAN‐2, TPA, elastase‐1, lipase, amylase, γ‐glutamyl transpeptidase, alkaline phosphatase, and lactate dehydrogenase), differentiated all 35 patients with pancreatic cancer from 32 patients with benign pancreatobiliary disease.…”