Platelet lymphocyte ratio a diagnostic challenge in pancreatic head masses

Venkatesh Bollineny, Sreeram Sateesh, Mahidhar Reddy, Konappa k, Manoj Kumar Reddy


Background: Masses in head of pancreas may arise from Carcinoma head of pancreas or Chronic pancreatitis. There is a need for differentiating the type of pancreatic head masses with utmost priority, since it can convert a radical surgery to conventional procedure. Recent studies suggest that Platelet lymphocyte ratio (PLR) can be used as a marker for differentiating between these masses. We evaluated the role of PLR and other tumour markers with combinations in differentiating the masses in head of the pancreas. Methods: A total of Sixty patients with mass in the head of pancreas with size 2cm or greater were included in the study, with 30 patients in the Pancreatic ductal adenocarcinoma (PDA) group and 30 patients in the Chronic Pancreatitis group. Patients with evidence of acute pancreatitis, liver cirrhosis, cholangitis and obstructive jaundice, having Lewis antigen A/B blood types, with absent tissue/cytological diagnosis were excluded. Results: Haematological parameters like platelet count, neutrophil count, lymphocyte count were not statistically significanct between the two groups, whereas, Mean CA 19-9 levels, (PLR) Platelet lymphocyte ratio levels and (NLR) Neutrophil lymphocyte ratio in (PDA) Pancreatic ductal adenocarcinoma were higher than Chronic pancreatitis group. (P<0.05) In all these patients, biomarkers such as CA 19-9, Platelet lymphocyte ratio (PLR), Neutrophil lymphocyte ratio (NLR) and different combinations of these tumour markers were calculated, and their sensitivity, specificity,(PPV) Positive predictive value, (NPV) Negative predictive value and accuracy in differentiating malignant from benign pancreatic masses were established. The diagnostic accuracy of the tumour markers and their combinations are in the following order PLR> PLR+CA 19-9> CA 19-9> CA 19-9+NLR> NLR. Conclusion: We found that PLR is as good as tumour marker CA 19-9 both individually as well as with other tumour marker combinations in the diagnosis of pathology of pancreatic head masses. Cost effectiveness, availability, simplicity and better diagnostic accuracy made PLR better tumour marker in the current scenario.

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