A prospective multicenter trial evaluating diagnostic validity of multivariate analysis and individual serum marker in differential diagnosis of pancreatic cancer from benign pancreatic diseases

Recent Trends in Biosensing and Diagnostic Methods for Novel Cancer Biomarkers

Cancer is one of the major public health issues in the world. It has become the second leading cause of death, with approximately 75% of cancer deaths transpiring in low- or middle-income countries. It causes a heavy global economic cost estimated at more than a trillion dollars per year. The most common cancers are breast, colon, rectum, prostate, and lung cancers. Many of these cancers can be treated effectively and cured if detected at the primary stage. Nowadays, around 50% of cancers are detected at late stages, leading to serious health complications and death. Early diagnosis of cancer diseases substantially increases the efficient treatment and high chances of survival. Biosensors are one of the potential screening methodologies useful in the early screening of cancer biomarkers. This review summarizes the recent findings about novel cancer biomarkers and their advantages over traditional biomarkers, and novel biosensing and diagnostic methods for them; thus, this review may be helpful in the early recognition and monitoring of treatment response of various human cancers.

Endoscopic Ultrasonography is a Promising Tool for Preoperative Prediction of the Operability of Pancreatic Carcinoma

This work discussed the efficiency of endoscopic ultrasonography (EUS) as a diagnostic modality for early detection of pancreatic cancer. The present study was constructed by doing imaging modalities EUS on 24 patients admitted to surgery department in the faculty of medicine with suspected pancreatic malignancy. Pancreatic cancer was found more in older ages above 55 years predominately in males coming from rural areas presenting with abdominal pain with or without jaundice. Histopathological examination revealed that ductal adenocarcinoma represented by 70.83% of cases. This study also shows significant elevation in serum CA19-9 in the presenting cases to confirm a close relation between cancer pancreas and CA19-9 as a good biochemical marker for PC. EUS was found to be able to detect masses less than 20 mm in diameter. Moreover, EUS can accurately detect the mass nature. EUS showed correct information as regards lymph node involvement and vascular invasion which affected the results of respectability of pancreatic masses. Finally, this study clearly showed that EUS is an accurate pre-operative tool in the assessment of nodal staging, vascular invasion, and respectability in patients with pancreatic adenocarcinoma.

Recent advances in biosensor development for the detection of cancer biomarkers

Cancer is the second largest disease throughout the world with an increasing mortality rate over the past few years. The patient's survival rate is uncertain due to the limitations of cancer diagnosis and therapy. Early diagnosis of cancer is decisive for its successful treatment. A biomarker-based cancer diagnosis may significantly improve the early diagnosis and subsequent treatment. Biosensors play a crucial role in the detection of biomarkers as they are easy to use, portable, and can do analysis in real time. This review describes various biosensors designed for detecting nucleic acid and protein-based cancer biomarkers for cancer diagnosis. It mainly lays emphasis on different approaches to use electrochemical, optical, and mass-based transduction systems in cancer biomarker detection. It also highlights the analytical performances of various biosensor designs concerning cancer biomarkers in detail.

Multiple tumor marker protein chip detection system in diagnosis of pancreatic cancer

Background

The clinical stage of the disease at diagnosis often determines the prognosis and survival rate of a patient with pancreatic cancer. Early symptoms of pancreatic cancer are often not obvious on imaging (ultrasound, computed tomography (CT), and so on), and when patients present with weight loss, jaundice and abdominal pain and other symptoms, they are usually already in the advanced stages of pancreatic cancer. However, the examination of combined tumor markers might improve their sensitivity or specificity in aiding diagnosis.

Methods

Twelve tumor markers including AFP, CEA, NSE, CA125, CA15-3, CA242, CA19-9, PSA, f-PSA, FER, β-HCG and HGH were measured by the protein biochip detection in serum in 235 pancreatic cancer patients, 230 benign pancreatic disease patients and 240 healthy people.

Results

Positive detection rates of tumor markers were: CA19-9 (49.3%), CA125 (45.1%), FER (44.2%), CA242 (42.5%), CEA (38.6%), CA15-3 (36.7%), β-HCG (29.6%), AFP (24.5%), NSE (18.2%), PSA (19.5%), f-PSA (9.4%) and HGH (8.7%) respectively. There was significant difference in CA19-9, NSE, CEA, CA242 and CA125 by multi-tumor marker protein biochip detection among patients with cancer, benign disease and healthy people (P <0.05). The positive rate of 5 tumor markers was 94.9%, and this was much higher than that of any single marker.

Conclusion

The detection of CA19-9, NSE, CEA, CA242 and CA125 in the multi-tumor marker protein biochip system is helpful in the diagnosis of pancreatic cancer.

The clinical utility of CA 19-9 in pancreatic adenocarcinoma: diagnostic and prognostic updates

CA 19-9 and CEA are the most commonly used biomarkers for diagnosis and management of patients with pancreatic cancer. Since the original compendium by Steinberg in 1990, numerous studies have reported the use of CA 19-9 and, to a lesser extent, CEA in the diagnosis of pancreatic cancer. Here we update an evaluation of the accuracy of CA 19-9 and CEA, and, unlike previous reviews, focus on discrimination between malignant and benign disease instead of normal controls. In 57 studies involving 3,285 pancreatic carcinoma cases, the combined sensitivity of CA 19-9 was 78.2% and in 37 studies involving 1,882 cases with benign pancreatic disease the specificity of CA 19-9 was 82.8%. From the combined analysis of studies reporting CEA, the sensitivity was 44.2% (1,324 cases) and the specificity was 84.8% (656 cases). These measurements more appropriately reflect the expected biomarker accuracy in the differential diagnosis of patients with periampullary diseases. We also present a summary of the use of CA 19-9 as a prognostic tool and evaluate CA 19-9 diagnostic and prognostic utility in a 10-year, single institution experience.

-The advancement of biomarker-based diagnostic tools for ovarian, breast, and pancreatic cancer through the use of urine as an analytical biofluid

Despite considerable advancements, the development of effective cancer screening tools based on serum biomarker measurements has thus far failed to achieve a meaningful clinical impact. The incremental progress observed over the course of serum biomarker development suggests that further refinements based on novel approaches may yet result in a breakthrough. The use of urine as an analytical biofluid for biomarker development may represent such an approach. The unique characteristics of urine including a high level of stability, ease of sampling, and an inactive and low-complexity testing matrix offer several potential advantages over the use of serum. A number of recent reports have demonstrated the utility of urine in the identification of novel cancer biomarkers and also the improved performance of biomarkers previously evaluated in serum. In this review, advancements related to the use of urine biomarkers within the settings of ovarian, breast, and pancreatic cancer are presented and discussed. Findings regarding the identification of specific urine biomarkers for each disease are highlighted along with comparative analyses of urine and serum biomarkers as diagnostic tools.

Preoperative diagnosis of lymph node metastasis in biliary and pancreatic carcinomas: evaluation of the combination of multi-detector CT and serum CA19-9 level

BACKGROUND

It is difficult to diagnose lymph node metastasis in biliary and pancreas carcinomas before surgery.

AIM

The aim of this study was to assess the utility of the combination of multi-detector computed tomographic (MDCT) findings and serum carbohydrate antigen (CA)19-9 level in the diagnosis of lymph node metastasis in biliary and pancreas carcinomas.

METHODS

The subjects were 139 patients with biliary and pancreas carcinomas who underwent surgical resection. We calculated the positive predictive values (PPV), sensitivities, specificities, positive likelihood ratios (PLR) and accuracies of diagnosis by MDCT alone, serum CA19-9 level alone, and their combination.

RESULTS

The PPV and sensitivity were higher for node metastasis in hepatoduodenal ligament than in common hepatic artery (CHA) or para-aortic region (PAR). Specificity, accuracy and PLR were highest for CHA in biliary carcinoma. With pancreatic carcinoma, PLR was slightly higher in PAR compared to other regions. The sensitivity of CA19-9 for node metastasis was higher than that of MDCT, while the PPV, specificity, accuracy and PLR were low for both biliary and pancreas carcinoma. The combination of positive CT findings and high CA19-9 level had the highest positive rate for node metastasis for both types of carcinomas. Nodes around the supra-mesenteric vein could not be fully observed on CT.

CONCLUSION

The combination of high-resolution MDCT and CA19-9 is useful for the diagnosis of lymph node metastasis in biliary and pancreas carcinomas.

Preoperative serum TA90-IC as an adjunct to serum CA 19-9 in the diagnosis of pancreatic malignancy: a pilot study

PURPOSE

Because TA90, a 90-kDa immunogenic tumor-associated antigen, is expressed by pancreatic cancer cells, we hypothesized that the serum level of its immune complex with IgG (TA90-IC) might be a useful marker for diagnosis of pancreatic malignancy. We also wanted to compare TA90-IC with CA 19-9 in the diagnosis of pancreatic cancer.

METHODS

We undertook a retrospective study of prospectively collected sera from patients with histopathologically proven pancreatic malignancies. Patient sera were analyzed for TA90-IC and CA 19-9. Sera of sex-matched and age-matched healthy volunteers (controls) were analyzed for TA90-IC. The study was conducted at a tertiary medical center. Twenty-one patients with pancreatic malignancies and 29 controls, from whom sera had been obtained and cryopreserved, were included. A positive TA90-IC level was defined as an optical density >/= 0.410 at 405 nm following an enzyme-linked immunosorbent assay based on a murine monoclonal antibody. CA 19-9 levels were determined by immunoradiometric assay performed at outside laboratories (normal range, 0 to 37 U/mL).

RESULTS

Of the 21 patients, 14 had positive TA90-IC levels and 18 had increased CA 19-9 levels (67% vs 86%; p = 0.157). The TA90-IC levels were significantly higher in the cancer group than in the control group (p = 0.0003). Of the 3 patients with normal CA 19-9 levels, 2 had positive TA90-IC levels. The combination of both markers identified 95% of patients with pancreatic malignancy, a significantly higher diagnostic rate than that of either marker alone (p = 0.014). TA90-IC sensitivity was higher for stage II and III disease than for stage IV disease (82% vs 50%).

CONCLUSIONS

TA90-IC assay may improve the prediction of pancreatic malignancy when used in combination with CA 19-9 levels. Because TA90-IC appears to have improved diagnostic accuracy with smaller tumor burden, the role of TA90-IC as an adjunct to CA 19-9 in screening and monitoring progression of early disease warrants further investigation.

A Disposable Multianalyte Electrochemical Immunosensor Array for Automated Simultaneous Determination of Tumor Markers

Background: Automated and convenient multianalyte detection with high throughput is increasingly needed in clinical diagnosis. We developed a disposable 4-by-2 array for programmed simultaneous amperometric immunoassay of 4 tumor markers.

Methods: We used a screen-printed technique, 1-step immobilization method, and flow injection technique. We immobilized carcinoembryonic antigen, α-fetoprotein, β-human choriogonadotropin, and carcinoma antigen 125 as model analytes in a redox mediator–grafted, biopolymer-modified, screen-printed carbon electrode array to capture corresponding horseradish peroxidase-labeled antibodies in competitive immunoreactions. The simultaneous multianalyte immunoassay was automatically carried out to amperometrically monitor the mediator-catalyzed enzymatic response to hydrogen peroxide, which decreased in proportion to the concentrations of analytes in samples.

Results: The multianalyte immunosensor array had a throughput of 60 samples/h and allowed simultaneous detection of carcinoembryonic antigen, α-fetoprotein, β-human choriogonadotropin, and carcinoma antigen 125 in clinical serum samples with concentrations up to 188 μg/L, 250 μg/L, 266 IU/L, and 334 kIU/L, respectively. The detection limits (limits of the blank, mean of blank plus 3 SD) were 1.1 μg/L, 1.7 μg/L, 1.2 IU/L, and 1.7 kIU/L. The inter- and intraassay imprecision (CVs) of the immunosensor arrays were &lt;7.8% and &lt;9.0%, respectively. The immunosensor arrays were stable for 28 days.

Conclusions: This newly constructed immunosensor array provides a simple, automated, simultaneous multianalyte immunoassay with high throughput, short analytical time, and sufficiently low detection limits for clinical application. This method offers the capability of miniaturizing the multianalyte detection device.

Early detection and staging of adenocarcinoma of the pancreas

Early diagnosis is likely to improve the outcome and survival in patients who have pancreatic cancer. The sensitivity and specificity of current screening methods, however, limit their applicability to individuals at high risk for developing pancreatic cancer. Further development of serum markers may lead to improved diagnostic accuracy and allow screening to be implemented more broadly. Proteomic profiling and evaluation of panels of markers hold particular promise for the future. This article provides a review of current methods and results for the early detection and staging of pancreatic cancer, and discusses some potential areas for future development.

Systematic review of carbohydrate antigen (CA 19-9) as a biochemical marker in the diagnosis of pancreatic cancer

BACKGROUND

Although many biochemical markers have been examined in pancreatic cancer none are definitive for pre-operative diagnosis. This systematic review examines studies using biochemical markers for the diagnosis of pancreatic cancer in order to appraise their role in contemporary management algorithms.

METHODS

A search of the MEDLINE database was undertaken using the key words pancreatic neoplasm and serum tumour marker. Only studies providing original data on sensitivity and specificity are included and data are presented on diagnostic accuracy, effect of cholestasis and the relation of tumour stage to blood levels of markers.

RESULTS

CA 19-9 is the most extensively evaluated with pooled data from 2283 patients. The median sensitivity of CA 19-9 for diagnosis is 79 (70-90%) and median specificity 82 (68-91%). CA 19-9 elevation in non-malignant jaundice results in a fall in specificity. Combination with other markers improves accuracy.

CONCLUSION

As the most extensively evaluated marker, CA 19-9 should be used in contemporary algorithms for the diagnosis of pancreatic cancer. Elevated values should be repeated after relief of jaundice.

A cancer protein microarray platform using antibody fragments and its clinical applications

Antibody microarrays have shown great potential for measurement of either a spectrum of target proteins in proteomics or disease-associated antigens in molecular diagnostics. Despite its importance, the applications of antibody microarrays are still limited by a variety of fundamental problems. Among them, cross-reactivity significantly limits the multiplexing ability in parallel sandwich immunoassays. As a result, it is very important to design new capture probes in order to incorporate a universal label into the assay configuration. In this report, an antibody fragments (F(ab')2) microarray platform for serum tumor markers was developed. Each antigen was detected at different concentrations to assemble its calibration curve, and combinations of different markers were tested to examine the specificity of simultaneous detection based on the F(ab')2 microarrays. Diagnostics of serum samples with this cancer antibody microarray platform and immunoradiometric assays (IRMA) were also performed. Wide range calibration curves (0-1280 U mL(-1)) were obtained for each tumor marker. Comparative studies demonstrated that such F(ab')2 microarrays exhibited both moderately improved sensitivity and better specificity than full-sized monoclonal antibody microarrays. It is also demonstrated that this microarray platform is quantitative, highly specific and reasonably sensitive. More importantly, clinical applications of our F(ab')2 microarray platform for upwards of 100 patient serum samples clearly show its potential in cancer diagnostics.

Multiplex Measurement of Seven Tumor Markers Using an Electrochemical Protein Chip

An electrochemical immunosensor for performing multianalyte measurements of tumor markers is described. The sensor consisted of an array of immunosensing electrodes fabricated on a glass substrate. Each electrode contained a different immobilized antigen and was capable of measuring a specific tumor marker using electrochemical enzyme-based competitive immunoassay. Using this arrangement, multiple analytes could be measured simultaneously by performing the technical operations for a single assay. The biosensor was used to measure the concentrations of seven important tumor markers: AFP, ferritin, CEA, hCG-beta, CA 15-3, CA 125, and CA 19-9. The sensor had excellent precision and accuracy and was comparable in performance to single-analyte ELISAs (1.9-8.1% interassay CV; <2 ng/mL (or units/mL) detection limit for most analytes). Multianalyte assays provide significant advantages over single-analyte tests in terms of cost per test, labor, test throughput, and convenience. We anticipate that chip-based sensors, as described herein, will be suitable for the mass production of economical, miniaturized lab-on-a-chip devices that will have applications in a wide range of clinical, environmental, and biodefense applications.

Recent Trends and Advances in Immunodiagnostics of Solid Tumors

The development of new cancer immunodiagnostic tests measuring soluble markers can be divided along the lines of single analyte measurement versus multiplex analysis. In the measurement of single analytes, newly proposed test analytes still struggle with the same issues as their predecessors; namely, can the measurement of a single biomarker be sufficiently sensitive and specific for screening the general population? Probably the best example of this challenge is in the area of bladder cancer detection, where several newly identified markers are being clinically evaluated in multicenter trials. In order to surmount this hurdle, multiplex analysis has become an increasingly important research focus. By combining the statistical power of measuring many cancer-associated analytes, it is hoped that highly specific diagnostic tests can be developed that are suitable for screening the general population. Some of the most impressive data for multiplex cancer biomarker detection derive from a non-immunologic technique - mass spectroscopy. Multiplex analysis has also recently been applied to the measurement of serum antibodies to tumor-associated antigens. Recent data link the development of antibodies to tumor-associated antigens with the presence of solid tumors. This strategy is a departure from the more traditional assay format of measuring the antigens themselves, and is another promising emerging area of investigation for the early detection of solid tumors. Solid tumor analysis by quantitative immunohistochemical staining is another rapidly growing area of cancer immunodiagnosis. This field has become especially important in the context of pharmacodiagnostics - the coupling of cancer therapy to the outcome of a test measurement from a patient biopsy. Standardization and assay reproducibility appear to be the most significant challenges in this context. In summary, developments over the past several years give reason for excitement and optimism about the potential for cancer immunodiagnostics to meaningfully impact cancer patient survival. In this review we take a fresh look at the field of cancer immunodiagnostics, to identify these recent and emerging trends that may impact on clinical practice over the next few years.

Duct-penetrating sign at MRCP: usefulness for differentiating inflammatory pancreatic mass from pancreatic carcinomas

PURPOSE

To define the duct-penetrating sign at magnetic resonance (MR) cholangiopancreatography (MRCP) and to assess the usefulness of this sign for distinguishing an inflammatory pancreatic mass (IPM) from a conventional pancreatic carcinoma (CPC) compared with arterial phase computed tomography (hereafter, CT) and arterial phase MR imaging (hereafter, MR imaging).

MATERIALS AND METHODS

MRCP, CT, and MR images were compared by means of receiver operating characteristic (ROC) analysis for 11 IPMs and 43 CPCs. With the MRCP images, a morphologic classification of the main pancreatic duct (MPD) was attempted for all lesions. On the basis of this classification and the enhancement patterns of a lesion, all readers graded the presence of IPM or CPC on a five-point scale for all images.

RESULTS

On the MRCP images, the morphologic characteristics of the MPD were nonobstruction for IPM (28 of 33, 85%) and obstruction or irregular stenosis for CPC (124 of 129, 96%). At ROC analysis among all the techniques, MRCP images had the highest value (0.98) for significant areas under the ROC curve (CT, 0.84; MR, 0.76) (P <.001). For the duct-penetrating sign in the broad sense (nonobstructed MPD) and the sign in the narrow sense (only normal MPD), the sensitivity, specificity, and accuracy for diagnosis of IPM were 85%, 96%, and 94%, respectively, and 36%, 100%, and 87%, respectively.

CONCLUSION

The duct-penetrating sign on MRCP images was more helpful to distinguish IPM from CPC than were the enhancement patterns on CT and MR images.

Elevated levels of opioid growth factor in the plasma of patients with pancreatic cancer

Opioid growth factor (OGF, [Met5]-enkephalin) is an endogenous peptide that regulates the growth of human pancreatic cancer. To evaluate whether human subjects with pancreatic cancer have alterations in plasma levels of OGF, fasting blood samples were obtained from 15 patients with histologically confirmed pancreatic adenocarcinoma. Forty-five subjects with other malignancies, 20 patients with acute pancreatitis, and 30 aged-matched patients without cancer served as control populations. Individuals with pancreatic cancer had OGF values, as determined by radioimmunoassay, that were up to 7.3-fold greater than control subjects. No differences were found between OGF values obtained from patients with other malignancies, acute pancreatitis, or subjects without cancer. The sensitivity and specificity of OGF for pancreatic cancer were greater than either CA 19-9 or CEA. These data indicate that pancreatic cancer is associated with a marked increase in plasma OGF levels and suggest that this peptide may serve as a useful diagnostic tool in the screening for this disease.