Original Article
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World J Gastrointest Surg. Apr 27, 2013; 5(4): 97-103
Published online Apr 27, 2013. doi: 10.4240/wjgs.v5.i4.97
Predictors of malignancy in chronic calcific pancreatitis with head mass
Senthilkumar Perumal, Ravichandran Palaniappan, Sastha Ahanatha Pillai, Vimalraj Velayutham, Jeswanth Sathyanesan
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
Author contributions: Sathyanesan J proposed the study; Perumal S and Palaniappan R performed research and wrote the first draft; Perumal S and Pillai SA collected and analysed the data; Velayutham V and Sathyanesan J contributed to the design and interpretation of the study and to further drafts.
Correspondence to: Sastha Ahanatha Pillai, MS, Institute of Surgical Gastroenterology and Liver Transplantation, Government Stanley Medical College, Old Jail Road, Royapuram, Chennai, Tamil Nadu 600001, India. a_sastha@yahoo.com
Telephone: +91-98-94162563 Fax: +91-44-25289595
Received: December 4, 2012
Revised: January 25, 2013
Accepted: February 5, 2013
Published online: April 27, 2013
Processing time: 140 Days and 13.3 Hours
Abstract

AIM: 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.

CONCLUSION: Elevated Serum bilirubin and CA 19-9, and dilated MPD and CBD were useful in predicting malignancy in patients with CCP and head mass.

Keywords: Chronic calcific pancreatitis; Pancreatic head mass; Carcinoma head of pancreas; Risk factors of malignancy