THE ROLE OF CA 19-9 AND PLATELET LYMPHOCYTE RATIO (PLR) IN THE DIAGNOSIS OF PANCREATIC HEAD MASS

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THE ROLE OF CA 19-9 AND PLATELET LYMPHOCYTE RATIO (PLR) IN THE DIAGNOSIS OF PANCREATIC HEAD MASS

Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 35

Abstract

BACKGROUND Laboratory analysis is of limited benefit in the diagnosis of pancreatic cancer. Several tumour markers are available that can help in prognostication and diagnosis of pancreatic cancer. Carbohydrate antigen 19-9 (CA 19-9) is the traditionally accepted best marker available. However, its usefulness has two significant limitations. First, it is not specific for pancreatic cancer because it can be elevated in benign conditions, particularly those that cause obstructive jaundice. Secondly, its sensitivity is reduced by the fact that patients who test negative for Lewis blood group antigens A and B are unable to synthesise CA 19-9 and therefore do not express it in their serum. The role of new tumour marker Platelet Lymphocyte Ratio (PLR) has been defined recently in prognostication of carcinoma pancreas. Role of PLR in diagnosing and its efficacy after combining it with CA 19-9 is not well established. This study is being undertaken to assess the role of Platelet Lymphocyte Ratio (PLR) and CA 19-9 in determining nature of pancreatic head masses. The objective of the study is to assess the role of PLR and CA 19-9 in the diagnosis and management of pancreatic head mass; assess short-term (3 months) post-operative outcome in pancreatic head mass cases with high PLR ratio. MATERIALS AND METHODS It is a descriptive study. Patients suffering from neoplastic and inflammatory pancreatic head masses admitted in the Department of Surgical Gastroenterology and Liver Transplant in Bangalore Medical College and Research Institute, Bangalore, were taken for the study. This is a prospective study from October 2015 to November 2017. A total of 30 patients were included in the study. The sample size was taken for convenience during the study. RESULTS In this study, accuracy of CA 19-9 (37 U/mL) in differentiating carcinoma from chronic pancreatitis is 85% and 87% respectively. The accuracy of PLR in differentiating carcinoma from chronic pancreatitis is 84% and 83% respectively. But the accuracy for combination of CA 19-9 and PLR in differentiating carcinoma from chronic pancreatitis is 88% and 90% respectively. CONCLUSION The preoperative Platelet Lymphocyte Ratio (PLR) has been reported as a significant prognostic indicator in several digestive malignancies. Use of both CA 19-9 and PLR resulted in a significant improvement in the ability to identify those patients in pancreatic head malignancy in whom supplementary staging can be avoided safely. PLR, which has been used for prognostic purpose till now also has a diagnostic value. PLR is at least as good as CA 19-9 as diagnostic marker to differentiate between malignant and inflammatory head mass of pancreas. Combining CA 19-9 and PLR may increase the accuracy.

Authors and Affiliations

Nagesh N. S, Yogesh Biradar

Keywords

CA 19-9 - Carbohydrate Antigen 19-9 PLR - Platelet Lymphocyte Ratio.

EP ID EP544871
DOI 10.14260/jemds/2018/876
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