目的    研究胃肠癌相关抗原血清肿瘤标记物（CA19-9）检测影像学（CT和MRI）疑似胰腺癌的诊断价值。方法    回顾性分析浙江大学医学院附属第一医院肝胆胰外科2010年1月至2012年2月间影像学检查疑似胰腺癌267例病人临床资料。收集其影像学及CA19-9检测资料，统计在影像学检查疑似胰腺癌的前提下，CA19-9对胰腺癌诊断的敏感度、特异度、阳性率、假阳性率、阴性率、假阴性率。结果    267例病人中，确诊胰腺癌225例（83.0%），非胰腺癌42例（17.0%）。CA19-9对胰腺癌诊断的敏感度为76.9%，特异度为78.6%，阳性率为95.1%，假阳性率为4.9%，阴性率为38.8%，假阴性率为61.2%。结论    CA19-9可为影像学检查疑似胰腺癌病人的诊断提供有价值的线索。对于影像学检查疑似胰腺癌而CA19-9检测阴性的病人，应特别注意影像学检查假阳性可能，建议术前行胰腺穿刺明确诊断，排除慢性胰腺炎、胰腺神经内分泌肿瘤和实性假乳头状瘤等疾病。对于影像学及CA19-9均阳性的病人，具备手术指征者可直接行手术治疗。

Clinical value of serum CA19-9 in the diagnosis of suspected pancreatic cancer by imaging methods        WANG Wei-lin*, WU Ze-hui, ZHU Feng, et al. Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou310003, China
Corresponding author: ZHENG Shu-sen, E-mail:shusenzheng@zju.edu.cn
Abstract    Objective    To explore the clinical value of the combination of serum tumor marker CA19-9 and imaging methods (computed tomography and magnetic resonance imaging) in the diagnosis of pancreatic cancer. Methods    The clinical data of 267 patients with suspected pancreatic cancer by imaging methods admitted from January 2010 to February 2012 in Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital of Medical School of Zhejiang University were analyzed retrospectively. Results    In all 267 patients, 225 (83.0%) and 42 (17.0%) patients were diagnosed as pancreatic cancer and non-pancreatic cancer respectively. In the pancreatic cancer group, serum CA19-9 was elevated in 173 (76.9%) patients. Eighty-five patients with suspected pancreatic cancer by imaging methods had normal CA19-9 value. Among them, 52 (61.2%) patients were finally diagnosed as pancreatic cancer on pathology, and 33 (38.8%) patients as non-pancreatic cancer. One hundred and eighty-two patients with suspected pancreatic cancer by imaging methods had elevated CA19-9 value. Among them, 173 patients were finally diagnosed as pancreatic cancer on pathology and 9 patients as non-pancreatic cancer. Conclusion    Serum tumor marker CA19-9 may provide valuable clues for the diagnosis of pancreatic cancer which is suspected by imaging methods. As to CA19-9 negative patients, in whom pancreatic cancer is suspected by imaging methods, much more attention should be paid to the possibility of false positive results of imaging methods. Pancreas puncture before surgery is recommended to confirm the diagnosis and exclude the possibility of chronic pancreatitis, pancreatic neuroendocrine tumors and solid-pseudopapillary tumor, etc. As to patients with elevated CA19-9 and imaging methods suspected pancreatic cancer, operation is recommended.