RU2714595C1 - Method for differential diagnosis of pancreatic cancer and chronic pancreatitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to oncology and gastroenterology, and can be used to select a pancreatic disease management approach. Patient is examined for blood values and ultrasonography is performed. Each index is assigned, depending on the degree of severity, the points as corresponding coefficients: K₁, K₂, K₃, K₄ and so forth up to K₃₅. K = (K₁+K₂+K₃+K₄+K₅+K₆+K₇+K₈+K₉+K₁₀+K₁₁+K₁₂+K₁₃+K₁₄+K₁₅+K₁₆+K₁₇+K₁₈+K₁₉+K₂₀+K₂₁+K₂₂+K₂₃+K₂₄+K₂₅+K₂₆+K₂₇+K₂₈+K₂₉+K₃₀+K₃₁+K₃₂+K₃₃+K₃₄+K₃₅)/35. Sum of these points is determined, and if the value of the average score is K = 0.75 and less, chronic pancreatitis is diagnosed, while the value K = 0.95 and more shows pancreatic cancer.

EFFECT: method enables providing higher reliability of differential diagnostics at the primary stage of examination of a patient with a pancreatic pathology, reducing labour costs and ensuring availability of clinical indicators, blood indices and ultrasonic indices due to complex mathematical treatment.

1 cl, 5 tbl, 4 ex

Description

The alleged invention relates to medicine, namely to oncology and gastroenterology and can be used to select tactics for managing patients. The frequency of chronic pancreatitis (CP) is increasing worldwide. Over the past 30 years there has been a more than twofold increase in the incidence. The prevalence of the disease in Europe is 25-26.4 cases per 100 thousand people, in Russia - among adults - 27.4-50 per 100 thousand, in children 9-25 cases per 100 thousand. Over the past 10 years, the incidence rate among young people and adolescents grew 4 times. According to many authors, the prevalence of CP among the population of various countries varies from 0.2 to 0.68%, and among patients with a gastroenterological profile it reaches 6-9% [1]. Pancreatic cancer (pancreas) in 90% of cases is represented by pancreatic cancer, and in 75% of cases it is pancreatic head cancer. The incidence is 8.2 per 100 thousand population. Over the past 20-30 years, the incidence of pancreatic cancer in developed industrial countries has grown 2-4 times, is in 13th place of all oncological diseases for both sexes, while mortality from pancreatic cancer is 8th. By the time of diagnosis, only 10-15% of pancreatic tumors are potentially radically operable, and five-year survival even with radical surgical treatment does not exceed 0-20%, only with tumor sizes less than 2 cm it reaches 41%, which makes this disease almost fatal. Such disappointing treatment results are associated with the aggressiveness of the tumor itself, with the late diagnosis of the disease due to the non-specificity of the symptoms, the features of the anatomical location of the pancreas, and the complexity of visualization of this area [2,3,4,5].

The question of the differential diagnosis of pancreatic cancer and chronic pancreatitis has been haunting many scientists for quite some time now. However, literature data show that clinical, laboratory, instrumental, preoperative, and often intraoperative, including morphological, data cannot always give an accurate idea of the nature of focal formation in the pancreas. [6].

However, the issue of differential diagnosis of pancreatic cancer and CP cannot be considered unpromising. There is a need for the identification of biomarkers that allow, through a blood test, to diagnose pancreatic cancer in the early stages of the disease. [7].

The hormone PYY is involved in carcinogenesis of the pancreas. Peptide YY (PYY) - a hormone belonging to the family of neuropeptide Y, one of the peptides of the gastrointestinal tract. The active hormone is PYY 3-36. PYY secretion increases during meals; its production is likely to be under neurohumoral control, as its blood level rises before the nutrients eaten reach the distal small and large intestine, where the highest concentrations of PYY 3-36 were found [8, 9]. This process is actively disrupted in pancreatic cancer. [9,10] A study of these disorders will allow to identify and clarify additional clinical, functional and morphological indicators that appear against the background of CP and develop a method for timely prediction of oncotransformation, as well as identify reference points for early diagnosis of pancreatic cancer. [11] Currently, there are no works that comprehensively took into account all these indicators for the development of further unified schemes and algorithms for drug and surgical prevention of pancreatic cancer. The study of the above indicators in a comparative aspect was not conducted, which was the basis to suggest the presence of novelty in this application.

Analogue: as an example of differential diagnosis of pancreatic cancer and CP, a method is known, patented by Neustroev V.G. RF 2353301 - "A method for the differential diagnosis of pancreatic cancer and chronic pancreatitis" [3]. The essence of the invention is that, based on an analysis of the frequency of occurrence of various endo-ultrasonographic (EUS) signs, each such sign is assigned a digital equivalent in the order of changing its accuracy in the differential diagnosis of cancer and CP, which made it possible to create a scale for the total score of EUS symptoms. Among the diagnostic signs are the following: 1. The ratio of the predicted and real vertical sizes of the focal pancreatic formation; 2. The structure of the pancreas, taking into account the presence of focal formation; 3. The contour and lumen of the choledochus and (or) Wirsung ducts at the border with focal pancreatic formation; 4. Pancreatic drawing in the focus; 5. Deformation of the Wirsung duct; 6. The contour of the pancreas outside the focus; 7. Calcinates in the Wirsung duct; 8. Calcifications in the parenchyma of the pancreas. Each of the digital equivalents of the selected characteristics corresponds to a point in the regression analysis. Moreover, the sum of 325 or less points corresponds to the diagnosis of CP, 503 and more points - pancreatic cancer. The use of the scale made it possible to isolate a group of patients (77%), the accuracy of diagnosis of cancer and CP in which is 99.2 ± 12.5%, sensitivity 100 + 0.8%, specificity 97.8 ± 3.5%, PCR - 98, 7 ± 2.9%, PCR - 100 ± 0.8%. In the remaining group (23%), the accuracy of the scale was 80.0%), and for patients of this group an additional, including invasive diagnosis.

The disadvantages of the above method are: laboriousness and cost - endo-ultrasonography is a very expensive diagnostic method that requires the direct participation of a well-trained professional, expensive equipment that combines an endoscope and an ultrasound apparatus, the presence of a specialized office, compliance with aseptic and antiseptic rules. Therefore, the considered method for the differential diagnosis of pancreatic cancer and CP can be applied only at the level of highly specialized centers with the appropriate equipment, and hardly at the level of the primary treatment link. Also a disadvantage of this method is its one-sided approach to pancreatic pathology from the point of view of endo-ultrasonography. This instrumental method is the second level method in the diagnosis of pathology of the pancreato-duodenal zone after the "gold standard" - retrograde cholangio-pancreatography (RCP). Both chronic pancreatitis and pancreatic cancer in their own way alter the biochemical picture of blood, glycemic balance, the structure of the upper part of the digestive tube (FGDS), and also have their own significant anamnestic and objective physical characteristics. Therefore, despite the high accuracy and sensitivity of the above method, it cannot be unequivocally recognized as generally applicable in the clinic

For the closest analogue, the invention of Hubergrits NB and others "A method for the differential diagnosis of chronic pancreatitis and pancreatic cancer" - RF patent 2157535 [4]. The method is as follows: in the patient’s blood determine the activity of the phospholipase A enzyme and the concentration of carbohydrate antigen 19.9 (CA-19-9), the leukocyte migration index by the inhibition reaction with pancreatic antigens, and a differential diagnostic indicator is calculated based on the ratio of a hundred-fold activity of phospholipase A to the product leukocyte migration index and concentration of carbohydrate antigen 19.9. With values of the calculated indicator exceeding the number 19.8, chronic pancreatitis is diagnosed, pancreatic cancer is lower than 14.4, and with values from 14.4 to 19.8 - the absence of pancreatic pathology.

The authors acknowledge that: “each of the listed indicators is not specific in the diagnosis of CP or pancreatic cancer: PLA activity can increase with inflammatory events in the pancreas of any nature, as well as with diseases of other organs of the gastrointestinal tract; marker CA-19-9 is determined in blood serum with tumors of the pancreas, stomach, liver, gall bladder, lungs; leukocyte migration index is an assessment of the inhibition of leukocyte migration with antigens and characterizes the degree of leukocyte sensitization to a particular antigen. And the ratio of all three indicators, corresponding to the given formula, turned out to be a high-precision differential diagnostic indicator (DDP) in determining the diagnosis of CP and pancreatic cancer. The ratio of these indicators within the selected numerical limits is strictly specific for these two pancreatic pathologies. "

The disadvantages of this method were indicated by the authors themselves in the description of the patent: this is not the specificity of each of the markers that determine the DDP, and therefore the prognosis. The value of DDP, according to the authors, was established empirically on 118 patients, that is, empirically, without using a specific evidence base, although the text indicates that "the measurements are reliable." There is no description of the statistical procedure or methods by which prognostic numerical values were derived; there is no unambiguous explanation of the reason for choosing a mathematical formula with an unproven sequence of arithmetic operations as a differential diagnostic tool. The markers used in the invention require mandatory determination, since when one of them falls out for any reason, the method ceases to “work” and loses its meaning. In addition, if the levels of phospholipase A and CA-19-9 in medical institutions are determined routinely, then the leukocyte migration index in the inhibition reaction with pancreatic antigens is hardly widespread and cheap. All this determines the difficulties of the widespread introduction of this method in the differential diagnosis algorithms, low socio-economic efficiency. Thus, the closest analogue does not provide reliable and complete information when deciding on the differential diagnosis of pancreatic cancer and chronic pancreatitis, and there is a need to develop additional diagnostic criteria.

Tasks:

1. Decrease in labor input.

2. Reduction of labor costs in the differential diagnosis at the initial stage of the study upon admission of a patient with pathology of the pancreas for the detection of pancreatic cancer or chronic pancreatitis.

3. Improving reliability.

The essence of the invention is that the complex reveals clinical indicators (gender, age, body mass index, the presence or absence of yellowing of the skin, concomitant diseases, epigastric pain, weakness, headache, dizziness, nausea), blood counts (blood glucose, alanine aminotransferase, aspartate aminotransferase, blood cholesterol, total bilirubin, alkaline phosphatase, C-reactive protein, total blood protein, creatinine, alpha amylase, urine amylase, prothrombin time, PYY hormone, presence or absence: leuko cytosis, reduction of red blood cells) and ultrasound parameters (dimensions and contours of the pancreas, echogenicity and echostructure of the pancreas. presence or absence: regional lymphadenopathy, pancreatolitis in the pancreatic parenchyma, involvement of vascular pathology in the projection of pancreatoduodenal zone, cysts in the pancreatic parenchyma), while each the indicator is assigned points depending on the severity as the corresponding coefficients: K1, K2, K3, K4, etc. to K35, - then determine the sum of these coefficients (K) according to the formula

K = (K1 + K2 + K3 + K4 + K5 + K6 + K7 + K8 + K9 + K10 + K11 + K12 + K13 + K14 + K15 + K16 + K17 + K18 + K19 + K20 + K21 + K22 + K23 + K24 + K25 + K26 + K27 + K28 + K29 + K30 + K31 + K32 + K33 + K34 + K35) / 35, where 35 is the number of significant coefficients, and provided that K = 0.75 or less, chronic pancreatitis is determined, at K = 0.95 or more - pancreatic cancer.

EFFECT: complex identification of significant indicators and assessment of their average score allows to increase the reliability of the method (p <0.05) and reduce labor costs by 25-30% due to the diagnosis at an early stage of the examination of the patient.

To determine the differential diagnostic criteria, Wald's sequential analysis was used, which is based on probabilistic methods for comparing the frequency of each of the analyzed parameters in the studied groups - patients with pancreatic cancer and patients with CP, while for the subsequent differential diagnosis, only those criteria that are reliably used (p <0.05) differ in these groups. They are calculated using the statistical computer program "Biostat". Prospectively and retrospectively, observation maps for 88 patients were analyzed, of which, in the proposed method, 41 were diagnosed with pancreatic cancer and 47 with CP. Comparative analysis among patients of the studied groups were subjected to 35 differential diagnostic criteria significantly (p <0.05), differing in frequency of occurrence. The obtained criteria are presented in the table:

The method is as follows: when conducting a differential diagnostic search in a patient with pathology of the pancreas in the complex (see Table 1): clinical indicators: gender, age, body mass index, presence or absence: yellowing of the skin, concomitant diseases (cardiac vascular, diabetes mellitus and others), epigastric pain, weakness, headache, dizziness, nausea; blood counts: blood glucose: alanine aminotransferase, aspartate aminotransferase, blood cholesterol, total bilirubin, alkaline phosphatase, C-reactive protein, total blood protein, creatinine, alpha amylase, urine amylase; prothrombin time, PYY hormone, presence or absence: leukocytosis, erythrocyte reduction, also evaluate ultrasound parameters: pancreatic dimensions, irregularity and fuzziness of the pancreatic contours, echogenicity and echostructure of the pancreas, presence or absence: regional lymphadenopathy, pancreatolitis in the pancreatic parenchyma, involvement vessels in the projection of the pancreatoduodenal zone, cysts in the pancreas parenchyma, then, for each indicator, points are calculated as the corresponding coefficients: K1, K2, K3, K4, etc. to K35, determine the sum of these coefficients (K) according to the formula

K = (K1 + K2 + K3 + K4 + K5 + K6 + K7 + K8 + K9 + K10 + K11 + K12 + K13 + K14 + K15 + K16 + K17 + K18 + K19 + K20 + K21 + K22 + K23 + K24 + K25 + K26 + K27 + K28 + K29 + K30 + K31 + K32 + K33 + K34 + K35) / 35, where 35 is the number of significant coefficients, and provided that K = 0.75 or less, chronic pancreatitis is determined, at 0 , 95 and more - pancreatic cancer.

Example 1

Patient Z., 60 years old, was admitted to the Department of Gastroenterology 02.01.17. Complaints: pain around the navel and nausea after eating. From the anamnesis: pain first appeared in August 2015 after eating. In October 2015, a course against chylakobacteria was prescribed, after which the pain went away for two months, but then returned. Parion was appointed, creon but pain continued. Ill with diabetes. Objectively: height 163 cm, weight 60 kg. When viewed from the general condition of moderate severity, the skin is of normal color. Palpation - soreness in the navel. Laboratory data: general blood test - erythra. 5.0 million, lake. 5.2 thousand, a blood clot. 162 thousand, ESR 3 mm / h, glucose 8.2 mmol / L, total bilirubin 13.6 μmol / L, ALT 40 U, ACT 20 U, blood amylase 82 U, alkaline phosphatase 123 U, GGT 31 U, cholesterol 7 , 31 mmol / L, PTV 12.8 sec, MHO 1.0 lipase 63 U / L, fecal occult blood test: not found. Instrumental data: ultrasound: pancreas - medium size, head - 25 mm, body - 21 mm, tail - 27 mm, increased echogenicity of the pancreatic parenchyma, structure diffusely heterogeneous, contours uneven, fuzzy; no pancreatoliths. The presence of regional lymphadenopathy. Wirsung duct not enlarged, unknown, no wirsungolites; Liver - the right lobe is 152 mm, the left lobe is 64 mm, the contours are even, the structure is homogeneous, the echogenicity is closer to the middle, the edge is sharp, the vascular pattern is normal, the intrahepatic bile ducts are not dilated, the portal vein is 10 mm, the common bile duct is not dilated, 3 mm, the walls normal thickness, the content is homogeneous, its extent is traced to the confluence of the duodenum, gall bladder is of normal shape, normal size, wall of normal thickness, homogeneous structure, content is homogeneous; there is no involvement of vessels in the pathological process in the projection of the pancreatoduodenal zone. CT: change in the pancreas, most likely, have a post-inflammatory character. Video esophagogastroduodenoscopy: Conclusion:

Endoscopic picture

superficial gastritis.

T.O. K = (0 + 0.9 + 0 + 0.88 + 0.47 + 0 + 0.44 + 0 + 0 + 0 + 0 + 3.97 + 0.4 + 0 + 0 + 0.54 + 0 + 0 + 0 + 0 + 0 + 0 + 0 + 0 + 0.63 + 0 + 0.29 + 0 + 0 + 0 + 0.06 + 0 + 0 + 0 + 0) / 10, where 10 is the number significant coefficients. K = 0.95 means a diagnosis of pancreatic cancer. The patient was prescribed surgery and already histologically postoperatively confirmed the diagnosis of pancreatic cancer. It can be concluded that neither the anamnesis data, nor laboratory data, nor even instrumental data confirmed the diagnosis of pancreatic cancer. On the 10th day after surgery, the patient was discharged in satisfactory condition.

Example 2

Patient G., 49 years old, was admitted to the department of gastroenterology 06/08/17. Complaints: nausea and abdominal discomfort 2 hours after eating. From the anamnesis: the above complaints are noted over the past 3 years. Objectively: height 174 cm, weight 70 kg, body mass index (BMI) = 23.4 kg / m ² . On examination, the general condition of moderate severity, the skin is pale. Palpation - the abdomen is soft without painful. The liver is not enlarged according to Kurlov, the edge is sharp, elastic, the spleen is not palpable, local discomfort in the Schoff-ra zone, the point of De Jardin is determined. Laboratory data: general blood test - blood glucose 4.2 mmol \ l, erythro. 3.0 million, lake. 5.5 thousand, blood clot. 160 thousand, ESR 6 mm / h, total bilirubin 20.0 μmol / L, ALT 40 U, ACT 45 U, total protein 45.0 g / L, blood amylase 70 U, alkaline phosphatase 150 U, GGT 40.1 U, C-peptide level 1.33 ng / ml, urine amylase 300 U / L. PYY hormone above 0.02 ng / ml Instrumental data: ultrasound: ultrasound signs of diffuse changes in the pancreatic parenchyma, cholecystolithiasis. Details: pancreas - dimensions are not increased, head - 25 mm, body - 20 mm, tail - 25 mm, structure is not uniform, contours are even, clear; there are no pancreatoliths in the parenchyma; The Wirsung duct expanded to 10 mm, unbroken, without wirsungolites; Liver - the right lobe is 140 mm, the left lobe is 45 mm, the contours are even, clear, the structure is homogeneous, the echogenicity is normal, the edge is rounded, the vascular pattern is normal, the intrahepatic bile ducts are not dilated, the portal vein is 9 mm, the common bile duct is not dilated, 5 mm, the walls are ordinary thickness, the content is uniform, can be traced along the length until it enters the duodenum, the gallbladder is of normal shape, normal size, wall of normal thickness, homogeneous structure, contents - several small, mobile stones up to 3-4 mm; there is no regional lymphadenopathy in the projection of the pancreatoduodenal zone. FGDS: Catarrhal gastritis. Duodeno-gastric reflux. The duodenal mucosa of the duodenum is hyperemic, contains single flat erosions. Lymphangiectasia in the duodenum was not detected.

As a result of the analysis, K = (0.8 + 0 + 0 + 0 + 0 + 0 + 0.44 + 0 + 0 + 0 + 0.69 + 0 + 0 + 0 + 0.93 + 0 + 0.9 + 0 + 0 + 0.9 + 0 + 0 + 0 + 0 + 0 + 0.57 + 0 + 0 + 0 + 0 + 0 + 0 + 0 + 0 + 0) / 7, where 7 is the number of significant coefficients . The value of the average differential diagnostic score of 0.75, i.e. concluded that the patient has chronic pancreatitis. After the appointment of treatment, the patient's condition improved, blood tests returned to normal, the dynamics of the ultrasound picture improved, indicating a correctly diagnosed diagnosis.

Example 3. Patient D., 45 years old, was admitted to the department of gastroenterology 11/23/16. Complaints: weakness, headache, dizziness and heaviness immediately after eating. From the anamnesis: the above complaints are noted over the past 9 months. Objectively: height 175 cm, weight 85 kg, body mass index (BMI) = 27.8 kg / m ² . On examination, the general condition of moderate severity, the skin is pale. Palpation - the abdomen is soft, painless. The liver is 11 * 9 * 8 cm according to Kurlov, the edge is sharp, elastic, the spleen is not palpable. Laboratory data: general blood test - erythra. 5.3 million, lake. 8.4 thousand, a blood clot. 146 thousand, ESR 19 mm / h, total bilirubin 19.39 μmol / L, ALT 55 U, ACT 30 U, total protein 40.0 g / L, blood amylase 41.0 U, alkaline phosphatase 100 U, GGT 48 , 1 unit / liter. Urine amylase 500 units / liter. PYY hormone above 0.02 ng / ml Instrumental data: ultrasound: ultrasound signs of pronounced diffuse changes in the pancreatic parenchyma, cholecystolithiasis. Details: pancreas - dimensions are not increased, head - 25 mm, body - 10 mm, tail - 20 mm, echogenicity of the parenchyma is increased, the structure is uniform, the contours are uneven, fuzzy, the presence of pancreatolites in the pancreas parenchyma. The Wirsung duct expanded to 10 mm, unbroken, without wirsungolites; Liver - the right lobe is 140 mm, the left lobe is 45 mm, the contours are even, clear, the structure is homogeneous, the echogenicity is normal, the edge is rounded, the vascular pattern is normal, the intrahepatic bile ducts are not dilated, the portal vein is 10 mm, there is a single hypoechoic formation in the 3 segment, not bile duct enlarged, 5 mm, walls of normal thickness, homogeneous contents, can be traced to run into the duodenum, gall bladder of normal shape, normal size, wall of normal thickness, uniform structure, contents are somewhat shallow x, mobile stones up to 3-4 mm; there is no regional lymphadenopathy in the projection of the pancreatoduodenal zone, the portal-mesenteric joint along the lateral contour is adjacent to the described changes in the pancreatic head. FGDS: Catarrhal gastritis. Erosion of the stomach. Bulbit. Erosion of the duodenal bulb. Duodeno-gastric reflux. The duodenal mucosa of the duodenum is hyperemic, contains single flat erosions. Lymphangiectasia in the duodenum was not detected.

Substituting the values in the formula, we obtain K = (0 + 0 + 0 + 0 + 0 + 0.79 + 0 + 0 + 0 + 0.44 + 0 + 0 + 0 + 0.96 + 0 + 0 + 0 + 0 + 0 + 0 + 0 + 0 + 0 + 0.74 + 0.63 + 0 + 0.29 + 0 + 0 + 0.75 + 0 + 1.5 + 0 + 0 + 0) / 7, where 7 - the number of significant coefficients. As a result of the survey, the value of the average differential diagnostic score of 0.76, which corresponds to an uncertain diagnosis. After prescribing treatment for chronic pancreatitis, the patient's condition became slightly better, blood tests returned to normal, the ultrasound picture improved in dynamics, which probably indicates a diagnosis of CP, but the risk of developing PCa remains. This patient is under our supervision.

Example 4. Patient O., 45 years old, was admitted to the Department of Gastroenterology 03/05/17. Complaints: severity after eating, diarrhea. From the anamnesis: notes the above complaints over the past 2 months. Objectively: height 163 cm, weight 52 kg, body mass index (BMI) = 19.6 kg / m ² . On examination, the general condition of moderate severity, the skin is pale. Palpation - the abdomen is soft, painless. The liver is not enlarged according to Kurlov, the edge is sharp, elastic, the spleen is not palpable, local discomfort in the Shoffar zone, the point of De Jardin is determined. Laboratory data: general blood test - blood glucose 4.0 mmol \ l, erythrum. 5.0 million, lake. 5.5 thousand, blood clot. 160 thousand, ESR 6 mm / h, total bilirubin 19.0 μmol / L, ALT 65 U, ACT 30 U, total protein 30.0 g / L, blood amylase 110 U, alkaline phosphatase 200 U, GGT 40.1 U, blood cholesterol 7.0 mmol / L, urine amylase 100 U / L. PYY hormone above 0.02 ng / ml Instrumental data: Ultrasound: ultrasound signs of diffuse changes in the pancreatic parenchyma. Details: pancreas - dimensions are not increased, head - 20 mm, body - 20 mm, tail - 15 mm, echogenicity of the parenchyma is mixed, the structure is not uniform, the contours are uneven, fuzzy; there are pancreatoliths in the parenchyma; The Wirsung duct is not enlarged 8 mm, unbroken, without Wirsungolites; Liver - the right lobe is 130 mm, the left lobe is 35 mm, the contours are even, clear, the structure is homogeneous, the echogenicity is normal, the edge is rounded, the vascular pattern is normal, the intrahepatic bile ducts are not dilated, the portal vein is 9 mm, the common bile duct is not dilated, 5 mm, the walls are ordinary thickness, homogeneous contents, can be traced to the duodenum, gall bladder of normal shape, normal size, wall of normal thickness, homogeneous structure, regional lymphadenopathy in the projection of pancreatoduodenal zone, thief spot-mesenteric compound of the lateral contour adjoins the described changes pancreas head. FGDS: Catarrhal gastritis. No lymphangiectasias in duodenum.

As a result of the analysis, K = (0.8 + 0 + 0 + 0 + 0 + 0 + 0.44 + 0 + 0 + 0 + 0.69 + 0 + 0 + 0 + 0.93 + 0 + 0.9 + 0 + 0 + 0.9 + 0 + 0 + 0 + 0 + 0 + 0.57 + 0 + 0 + 0 + 0 + 0 + 0 + 0 + 0 + 0) / 7, where 7 is the number of significant coefficients . The value of the average differential diagnostic score of 0.75, i.e. concluded that the patient has chronic pancreatitis. After the appointment of treatment, the patient's condition improved, blood tests returned to normal, the dynamics of the ultrasound picture improved, indicating a correctly diagnosed diagnosis.

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Claims (3)

A method for the differential diagnosis of pancreatic cancer (PCa) and chronic pancreatitis (CP), characterized in that it reveals the clinical indicators, the blood counts of the patient and conduct an ultrasound examination, reflected in the complex in table 1 of the description, with each indicator being assigned depending on the degree severity scores as corresponding coefficients: K _l , K ₂ , K ₃ , K ₄ , etc. to K ₃₅ , then determine the sum of these coefficients (K) according to the formula K = (K ₁ + K ₂ + K ₃ + K ₄ + K ₅ + K ₆ + K ₇ + K ₈ + K ₉ + K ₁₀ + K ₁₁ + K ₁₂ + K ₁₃ + K ₁₄ + K ₁₅ + K ₁₆ + K ₁₇ + K ₁₈ + K ₁₉ + K ₂₀ + K ₂₁ + K ₂₂ + K ₂₃ + K ₂₄ + K ₂₅ + K ₂₆ + K ₂₇ + K ₂₈ + K ₂₉ + K ₃₀ + K ₃₁ + K ₃₂ + K ₃₃ + K ₃₄ + K ₃₅ ) / 35, where 35 is the number of significant coefficients, and provided that K = 0.75 or less, chronic pancreatitis is determined, with K = 0.95 or more, pancreatic cancer.