Preoperative differential diagnosis of benign and malignant pancreatic lesions--the value of pancreatic secretory trypsin inhibitor, procarboxypeptidase B, CA19-9 and CEA

BACKGROUND/AIMS: Pancreatic secretory trypsin inhibitor (PSTI). Procarboxypeptidase B (PCPB or Human pancreas-specific protein HPASP), CA19-9 and CEA were evaluated for their performance in preoperative differential diagnosis of benign and malignant pancreatic lesions. METHODOLOGY: Our prospective study included 92 patients with pancreatic lesions diagnosed by imaging techniques. In 45 of them (group I), the lesions turned out to be malignant tumors (35 pancreatic cancer, 10 other carcinoma of the pancreatic region); 47 patients (group II) had benign lesions (38 inflammatory disease of the pancreas, 9 other benign lesions). RESULTS: Statistical analysis showed significant differences between these two groups for PSTI, PCPB and CA19-9, but not for CEA. When only pancreatitis versus pancreatic cancer was analyzed, differences were more significant for PSTI and PCPB, but less significant for CA19-9. Because of a strong trend toward false positive values in patients with pancreatic inflammation, the specificity of CA19-9 in our selected patient group was only 67%, but in combination with normal PSTI (< 13.5 ng/ml), it reached 96%. CONCLUSION: In our study, PSTI and PCPB were useful markers for pancreatitis. PSTI also showed good correlation with the severity of the inflammation and provided additional preoperative information, in combination with CA19-9.