Chart

FNA || Spyglass || CT || MRI || PET || MRCP || ERCP || CA-494 || CA19-9 || DR70^^ || Outpatient Imaging Centers: $700 - $1000 || $3000- $6000 with NO coverage from Medicare! ||  || $1145 || $1346 || $225 ||   || $100 || ^ **Management of pancreaticobiliary disease using a new intra-ductal endoscope: The Texas experience**
 * || US || EUS || EUS
 * Sensitivity || 90%* ||  ||   || 100%^ || 83.35% || 89% || 90% || 77% || 80% || 90% || 88% || 90% ||
 * Specificity || 90%* ||  ||   || 77%^ || 75% || 77% || 81% || 65% || 61% || 94% || 85% || 93% ||
 * Accuracy || 93%* ||  ||   ||   || 81.5% || 96% || 87% || 72% ||   ||   ||   ||   ||
 * Cost || $200 || $1111 ||  || $617 || Hospitals: $1750 - $2200
 * Degree of Complication || 0% ||  ||   || 6%^ || None ||   || None, Time becomes a huge factor, though. ||   ||   ||   ||   ||   ||
 * Dangers || Image easily obstructed by the bowels; up to interpretation of lab assistant/doctor ||  ||   || Cholangitis - bacterial infection on biliary tree^ || Radiation exposure, but there is no data connecting CT to radiation deaths. || None || Radiation exposure to gamma rays ||   || Invasive, ||   ||   ||   ||
 * Pancreatic neoplasms: how useful is evaluation with US?

Problem: >> Not whole population because
 * 1) What is known?
 * 2) Survival<1% of 5 years
 * 3) Pancreatic Cancer is the fourth leading cancer killer
 * 4) CA19-9 Specificity is 85% (low sensitivity)
 * 5) 35240/42450 die 2009 (est.)
 * 6) What is not known?
 * 7) Current methods?
 * 8) Future methods?
 * 9) Demographics?
 * 10) What needs to be done?
 * 11) Recommend screening test to increase sensitivity without sacrificing specificity while identifying populations at higher risk.
 * 12) How we addressed the problem?
 * 13) Compare current methods quantitatively
 * 14) Selective targeting using demographics (high risk population)
 * 15) Credible sources/ large sample size
 * 16) Say: No current recommendation; we aim to change that and look for screening recommendations to implement based on:
 * 17) Familial Pancreatic Cancer
 * 18) High Risk Lifestyle Choice
 * 19) Smoking
 * 20) Obesity
 * 1) low percentage of incidence
 * 2) expensive tests?
 * BMED 1300 – Spring 2010**


 * PROBLEM ONE: Pancreatic Cancer Screening**

Carcinoma of the pancreas has markedly increased over the past several decades and ranks as the fourth leading cause of cancer death in the United States. In 2009, of the estimated 42,470 new cases of pancreatic cancer, 35,240 will result in deaths (American Cancer Society, 2006). The overall survival rate at all stages is <1% at 5 years with most patients dying within 1 year. At present there are no reliable screening tests for detecting pancreatic cancer in asymptomatic persons. The deep anatomic location of the pancreas makes detection of small, localized tumors unlikely during the routine abdominal examination. Even in patients with confirmed pancreatic cancer, an abdominal mass is palpable in only 15-25% of cases. Among healthy subjects, CA19-9, a serologic marker potentially used for screening, has good specificity---85% (Safi, Schlosser et al. 1996) but nevertheless generates a large proportion of false-positive results due to the very low prevalence of pancreatic cancer in the general population. The predictive value of a positive test could be improved if a population at substantially higher risk could be identified. Your team has been selected by the National Cancer Institute to investigate and evaluate current methods for pancreatic cancer screening, including the effectiveness of the most commonly used methods. You are then expected to identify and make recommendations regarding potential future screening strategies, which relative to current strategies improve the sensitivity without sacrificing specificity.

Safi, F, Schlossew,W, Falkenreck, S and Beger, H.G (1996) //Ca 19-9 serum course and prognosis of pancreatic cancer.// International Journal of Gastrointestinal Cancer. 20/3.

 * PRESENTATIONS: TUESDAY, FEB 9**
 * REPORT DUE: TUESDAY, FEB 16

Sources with description of what was found from it:

Scheiman, J. M., R. C. Carlos, et al. (2001). "Can endoscopic ultrasound or magnetic resonance cholangiopancreatography replace ERCP in patients with suspected biliary disease? A prospective trial and cost analysis." The American Journal of Gastroenterology 96(10): 2900-2904. ---Cost for ercp, mrcp, and eus.

Hänninen, E. L., J. Ricke, et al. (2005). "Magnetic Resonance Cholangiopancreatography: Image Quality, Ductal Morphology, and Value of Additional T2‐ and T1‐weighted Sequences for the Assessment of Suspected Pancreatic Cancer." Acta Radiologica 46(2): 117-125. ---Sensitivity and specificity and accuracy of MRCP **