Clinicopathological features in misdiagnosed pancreatic carcinoma

There is more potential for misclassification of adenocarcinoma of the pancreas than for many other cancers because of the difficulty of accurate diagnosis.

We analyzed the clinicopathological features of 105 patients who were suspected of having unresectable adenocarcinoma of the pancreas on their 1st visit to our outpatient clinic.

Ten of 105 patients (10%) had been misdiagnosed as having pancreatic carcinoma. The final diagnoses were made mainly using dynamic computed tomography (CT) and/or histologic examination. The incidence of weight loss (> or = 7% of total-body weight, within 6 months before diagnosis) in the misdiagnosed patients was significantly lower than that in pancreatic carcinoma patients (30% vs. 67%, p=0.02). Serum CA19-9 abnormality (> 100 U/ml) was observed less frequently in the misdiagnosed patients than in the patients with pancreatic carcinoma (40% vs. 77%, p=0.01). The detection of a dilated main pancreatic duct and/or pancreatic mass by imaging modalities was less frequent in the misdiagnosed patients (p<0.01).

Dynamic CT and/or histologic examination may be essential when making a definite diagnosis of advanced pancreatic carcinoma. In addition, weight loss, serum CA19-9 abnormality, detection of a dilated main pancreatic duct and/or pancreatic mass may also be useful in making a differential diagnosis of this disease.