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Pancreatic Cancer: Likelihood Ratios

Introduction: None written.

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The likelihood ratios of findings for Pancreatic Cancer are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Biopsy
Finding	Result	+LR	-LR
[ + ] Endoscopic Ultrasound-Guided FNA	+ 0 -	inf	0.2
Endoscopic ultrasound FNA biopsy Sensitivity 85-90%. Specificity nearly 100%. Note: Lymph nodes may also be able to be biopsied. Study: Endoscopic ultrasound-guided real-time fine-needle aspiration biopsy of the pancreas in cancer patients with pancreatic lesions. Faigel DO; Ginsberg GG; Bentz JS; Gupta PK; Smith DB; Kochman ML J Clin Oncol 1997 Apr;15(4):1439-43. The clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of pancreatic carcinoma. Chang KJ; Nguyen P; Erickson RA; Durbin TE; Katz KD Gastrointest Endosc 1997 May;45(5):387-93.
[ + ] Percutaneous FNA biopsy	+ 0 -	40	0.2
Percutaneous FNA biopsy of a pancreatic mass can be performed using either US or CT guidance. Sensitivity from 80 to 90 and specificity from 98 to 100 percent. Study: Pancreatic cancer versus chronic pancreatitis: diagnosis with CA 19-9 assessment, US, CT, and CT-guided fine-needle biopsy. DelMaschio A; Vanzulli A; Sironi S; Castrucci M; Mellone R; Staudacher C; Carlucci M; Zerbi A; Parolini D; Faravelli A; et al. Radiology 1991 Jan;178(1):95-9.

Endoscopic
Finding	Result	+LR	-LR
[ + ] Endoscopic Ultrasound-Guided FNA	+ 0 -	inf	0.2
Endoscopic ultrasound FNA biopsy Sensitivity 85-90%. Specificity nearly 100%. Note: Lymph nodes may also be able to be biopsied. Study: Endoscopic ultrasound-guided real-time fine-needle aspiration biopsy of the pancreas in cancer patients with pancreatic lesions. Faigel DO; Ginsberg GG; Bentz JS; Gupta PK; Smith DB; Kochman ML J Clin Oncol 1997 Apr;15(4):1439-43. The clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of pancreatic carcinoma. Chang KJ; Nguyen P; Erickson RA; Durbin TE; Katz KD Gastrointest Endosc 1997 May;45(5):387-93.
[ + ] ERCP	+ 0 -	9	0.1
ERCP has a sensitivity and specificity of 90 to 95 percent in detecting pancreatic cancer. It is most useful if the CT or US does not reveal a mass lesion or if chronic pancreatitis is in the differential diagnosis. Tissue samples and/or brush cytology can be collected at the time of ERCP, but the sensitivity for detection of malignancy is probably lower than that of endoscopic ultrasound (EUS)-guided FNA. Study: UpToDate: Clinical manifestations, diagnosis, and surgical staging of exocrine pancreatic cancer

Imaging
Finding	Result	+LR	-LR
[ + ] Abdominal CT	+ 0 -	8.5	0.2
CT scan has a better sensitivity than, and similar specificity to US (85 to 90 and 90 to 95 percent, respectively) for the detection of pancreatic cancer (From UpToDate) Study: A prospective study of the value of imaging, serum markers and their combination in the diagnosis of pancreatic carcinoma in symptomatic patients. Pasanen PA; Eskelinen M; Partanen K; Pikkarainen P; Penttila I; Alhava E Anticancer Res 1992 Nov-Dec;12(6B):2309-14.
[ + ] Abdominal US	+ 0 -	7.5	0.3
The reported sensitivity and specificity of US in diagnosing pancreatic cancer is 75 to 89 and 90 to 99 percent (From UpToDate) Study: Clinical presentation and ultrasonography in the diagnosis of pancreatic cancer. Maringhini A; Ciambra M; Raimondo M; Baccelliere P; Grasso R; Dardanoni G; Lanzarone F; Cottone M; Sciarrino E; Pagliaro L Pancreas 1993 Mar;8(2):146-50. Abdominal US for diagnosis of pancreatic tumor: prospective cohort analysis. Karlson BM; Ekbom A; Lindgren PG; Kallskog V; Rastad J Radiology 1999 Oct;213(1):107-11.

Tumor Marker
Finding	Result	+LR	-LR
[ + ] CA 19-9	+ 0 -	5.9	0.3
At a cutoff value of 37 U/ml, sensitivity and specificity were 76.7% and 87.1%, respectively. Study: Am J Gastroenterol. 1999;94(7):1941. PMID: 10406263
[ + ] CA 50		No accuracy specified.
Study: no study specified.