title: Predictors of malignancy in chronic calcific pancreatitis with head mass.
abstract: OBJECTIVE
  To prospectively analyse the clinical, biochemical and radiological characteristics of the mass lesions arising in a background of chronic calcific pancreatitis (CCP).
  
  
  METHODS
  Eighty three patients, who presented with chronic pancreatitis (CP) and a mass lesion in the head of pancreas between February 2005 and December 2011, were included in the study. Patients who were identified to have malignancy underwent Whipple's procedure and patients whose investigations were suggestive of a benign lesion underwent Frey's procedure. Student t-test was used to compare the mean values of imaging findings [common bile duct (CBD), main pancreatic duct (MPD) size] and laboratory data [Serum bilirubin, carbohydrate antigen 19-9 (CA 19-9)] between the groups. Receiver operating characteristic curve (ROC curve) analysis was done to calculate the cutoff valves of serum bilirubin, CA 19-9, MPD and CBD size. The sensitivity, specificity, positive predictive valve (PPV) and negative predictive value (NPV) were calculated using these cut off points. Multivariate analysis was performed using logistic regression model.
  
  
  RESULTS
  The study included 56 men (67.5%) and 27 women (32.5%). Sixty (72.3%) patients had tropical calcific pancreatitis and 23 (27.7%) had alcohol related CCP. Histologically, it was confirmed that 55 (66.3%) of the 83 patients had an inflammatory head mass and 28 (33.7%) had a malignant head mass. The mean age of individuals with benign inflammatory mass and those with malignant mass was 38.4 years and 45 years respectively. Significant clinical features that predicted a malignant head mass in CP were presence of a head mass in CCP of tropics, old age, jaundice, sudden worsening abdominal pain, gastric outlet obstruction and significant weight loss (P ≤ 0.05). The ROC curve analysis showed a cut off value of 5.8 mg/dL for serum bilirubin, 127 U/mL for CA 19-9, 11.5 mm for MPD size and 14.5 mm for CBD size.
  
  
  CONCLUSIONS
  Elevated Serum bilirubin and CA 19-9, and dilated MPD and CBD were useful in predicting malignancy in patients with CCP and head mass.
authors.affiliation: Senthilkumar Perumal, Ravichandran Palaniappan, Sastha Ahanatha Pillai, Vimalraj Velayutham, Jeswanth Sathyanesan, Institute of Surgical Gastroenterology and Liver Transplantation, Government Stanley Medical College, Chennai 600001, India.
authors.forename: Senthilkumar
authors.initials: S
authors.lastname: Perumal
authors.forename: Ravichandran
authors.initials: R
authors.lastname: Palaniappan
authors.forename: Sastha Ahanatha
authors.initials: SA
authors.lastname: Pillai
authors.forename: Vimalraj
authors.initials: V
authors.lastname: Velayutham
authors.forename: Jeswanth
authors.initials: J
authors.lastname: Sathyanesan
keywords: Carcinoma head of pancreas; Chronic calcific pancreatitis; Pancreatic head mass; Risk factors of malignancy