Differential diagnosis of pancreatic diseases: new approaches in laboratory and radiologic diagnosis

Aim. To assess significance of serum fibronectin (FN) and new approaches of processing computed tomography (CT) results for pancreatic cancer (PC) and chronic pancreatitis (CP) differential diagnosis. Materials and methods. Data of 49 patients with pancreatic lesions who underwent multislice computed tomography (MSCT) with intravenous contrast enhancement and FN evaluation in 2018 were analyzed. There were 29 (59.2%) males and 20 (40.8%) females, mean age 51.9±13.9 (30–82). All patients were divided in 3 groups: 1 — PC (17 patients, 34.6%) — morphologically verified, 2 — chronic pancreatitis with previous pancreonecrosis (CPPN) — 16 patients, 32.7%, 3 — chronic calcifying pancreatitis (CCP) — 16 patients, 32.7%. We calculated median of enhancement gradient between region of interest and intact parenchyma (Мgrad) based on MSCT results. Pearson’s correlation coefficient (rp) was calculated for correlation assessment. Results. We assessed mean Мgrad and mean serum FN rate in all three groups: PC — 28.1±2.6, р=0.0001, CPPN — 14.9±2.4, р=0.07, CCP — 13.3±0.7, р=0.08 for Мgrad, and 239.8±30.1, p=0.8, 243.5±33.8, p=0.7, 227.2±34.3, p=0.8 for serum FN rate, respectively. There was statistically significant strong correlation of Мgrad in patients with PC (rp=0.63, p=0.0001). We revealed cut-off point of Мgrad value for PC that was 20 (p=0.001). There were no statistically significant correlations of serum FN rate in all groups (PC rp=0.04, p=0.8; CPPN rp=0.06, p=0.7; CCP rp=-0.03, p=0.8). Conclusions. Mgrad evaluation based on MSCT is an informative marker for differential diagnosis between PC and chronic pancreatitis, high rates of Мgrad positively correlate with PC existence. There was no correlation between serum FN rate and existence of PC, CPPN or CCP.