title: Malignancy in chronic pancreatitis: analysis of diagnostic procedures and proposal of a clinical algorithm.
abstract: BACKGROUND
  Pancreatic ductal adenocarcinoma (PDAC) is characterized by its poor prognosis, and some benign conditions and syndromes, including chronic pancreatitis (CP), are risk factors for pancreatic carcinoma. However, the differential diagnosis of CP from PDAC is difficult for clinicians because PDAC frequently causes inflammation within the pancreas. Therefore, patients with CP exhibit not only an elevated risk of cancer, but they are also in danger of underdiagnosis.
  
  
  METHODS
  The present study retrospectively analyzed 29 patients with pancreatic cancer who fulfilled our definition of "chronic pancreatitis" to identify characteristics to aid in the differential diagnosis between chronic pancreatitis with and without pancreatic cancer. All parameters were subjected to univariate analysis.
  
  
  RESULTS
  We identified several factors that differed significantly between the CP patients and patients with CP and synchronous PDAC, and these characteristics were used to develop a diagnostic algorithm. The performance of the algorithm was externally validated in a different panel of patients from the Department of Surgery, Medical Faculty Mannheim.
  
  
  CONCLUSIONS
  The present study succeeded in identifying characteristics that significantly differed in patients with and without PDAC in CP. These characteristics were integrated in a diagnostic algorithm that might help to improve diagnostic of PDAC in CP.
authors.affiliation: Department of Surgery, University Hospital Mannheim, University Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany. Felix.Rueckert@umm.de
authors.forename: Felix
authors.initials: F
authors.lastname: Rückert
authors.forename: Torsten
authors.initials: T
authors.lastname: Brussig
authors.forename: Matthias
authors.initials: M
authors.lastname: Kuhn
authors.forename: Stephan
authors.initials: S
authors.lastname: Kersting
authors.forename: Alfred
authors.initials: A
authors.lastname: Bunk
authors.forename: Maximilian
authors.initials: M
authors.lastname: Hunger
authors.forename: Hans-Detlev
authors.initials: HD
authors.lastname: Saeger
authors.forename: Marco
authors.initials: M
authors.lastname: Niedergethmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Post
authors.forename: Robert
authors.initials: R
authors.lastname: Grützmann
mesh_terms: D000328:Adult; D000465:Algorithms; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D050500:Pancreatitis, Chronic / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014463:Ultrasonography; D015431:Weight Loss