title: Predictors of cancer in patients with suspected pancreatic malignancy without a tissue diagnosis.
abstract: BACKGROUND
  The aim of this study was to identify predictive factors for malignancy in patients undergoing surgery for suspected pancreatic cancer without a preoperative tissue diagnosis.
  
  
  METHODS
  Patients were identified by International Classification of Diseases Ninth Revision and current procedural terminology codes, respectively, for pancreatic cancer and pancreaticoduodenectomy at a single tertiary referral center between January 1998 and May 2004. Data were collected retrospectively by chart review. Multivariate analysis of potential predictive factors was performed.
  
  
  RESULTS
  A total of 150 patients underwent surgery for documented or suspected pancreatic malignancy; 102 did not have a preoperative tissue diagnosis of cancer. Of these, 75 had neoplastic disease at surgery. Average weight loss was greater for those with malignancy (13.5 vs. 4.8 lbs; P = .014) as was mean bilirubin (6.1 vs. 3.3 mg/dL; P = .006). In multivariate analysis, a combination of weight loss >20 lbs, bilirubin >3 mg/dL, and CA 19-9 >37 U/mL had both a specificity and positive predictive value of 100% for predicting malignancy regardless of bile duct abnormalities or mass lesions on endoscopic retrograde cholangiopancreatography or endoscopic ultrasound, respectively. The positive predictive value decreased to 89.5% when any 2 of these findings were present. The presence of a mass on CT or EUS alone had a sensitivity of 84%; however, no other single finding had a sensitivity >65%.
  
  
  CONCLUSIONS
  In patients suspected of having a pancreatic malignancy, weight loss, hyperbilirubinemia, and increased CA 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.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, Henry Ford Hospital, Gastroenterology, K-7, 2799 West Grand Blvd., Detroit, MI 48202, USA. Drdtess@aol.com
authors.forename: David A
authors.initials: DA
authors.lastname: Tessler
authors.forename: Andrew
authors.initials: A
authors.lastname: Catanzaro
authors.forename: Vic
authors.initials: V
authors.lastname: Velanovich
authors.forename: Suzanne
authors.initials: S
authors.lastname: Havstad
authors.forename: Sachin
authors.initials: S
authors.lastname: Goel
mesh_terms: D001663:Bilirubin / Q000097:blood; D018395:CA-19-9 Antigen / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015431:Weight Loss
chemical_list: D018395:CA-19-9 Antigen; D001663:Bilirubin