Dr Tessler and colleagues from Detroit identified malignancy predictors in patients undergoing surgery for suspected pancreatic cancer.
The patients had no preoperative tissue diagnosis.
Patients were identified by International Classification of Diseases 9th Revision and current procedural terminology codes.
The researchers assessed patients presenting with pancreatic cancer and pancreaticoduodenectomy at a single referral center between 1998 and 2004.
Data were collected retrospectively by chart review.
The research team performed multivariate analysis of potential predictive factors.
A total of 150 patients underwent surgery for documented or suspected pancreatic malignancy.
The team noted that 102 did not have a preoperative tissue diagnosis of cancer.
|Bilirubin more than 3 mg/dL had a positive predictive value of 100% for malignancy|
|American Journal of Surgery|
Of these, 75 had neoplastic disease at surgery.
The researchers found that average weight loss was greater for those with malignancy.
Mean bilirubin was 6 mg/dL for those with malignancy vs. 3 mg/dL in those without.
In multivariate analysis, a combination of weight loss of more than 20 lbs had a specificity and positive predictive value of 100% for predicting malignancy.
The team noted that bilirubin more than 3 mg/dL, and cancer antigen 19-9 of more than 37 U/mL had a positive predictive value of 100% for malignancy.
All these were regardless of bile duct abnormalities or mass lesions on endoscopic retrograde cholangiopancreatography or endoscopic ultrasound.
The researchers observed that the positive predictive value decreased to 90% when any 2 of these findings were present.
The presence of a mass on computed tomography or endoscopic ultrasound or alone had a sensitivity of 84%.
However, the research team found no other single finding had a sensitivity more than 65%.
Dr Tessler's team commented, “In patients suspected of having a pancreatic malignancy, weight loss, hyperbilirubinemia, and increased cancer antigen 19-9 level may be predictive of a final cancer diagnosis.”
“Surgical exploration should be considered in these patients even in the absence of a preoperative tissue diagnosis.”