ПОИСК НОВЫХ ПОДХОДОВ К ДИФФЕРЕНЦИАЛЬНОЙ ДИАГНОСТИКЕ ЗАБОЛЕВАНИЙ ПОДЖЕЛУДОЧНОЙ ЖЕЛЕЗЫ

Aim. To assess significance of serum fibronectin and new approaches of computed tomography for pancreatic cancer and chronic pancreatitis differential diagnosis. Material and methods. Data of 49 patients with pancreatic lesions who underwent multislice computed tomography (MSCT) with intravenous contrast enhancement and serum fibronectin (FN) evaluation in 2018 were analyzed. There were 29 (59.2%) males and 20 (40.8%) female patients, mean age 51.9+13.9 (30-82). All patients divided in 3 groups: 1 - with pancreatic ductal adenocarcinoma (PDAC) - 17 p., 34.6%, 2 - chronic pancreatitis with previous pancreonecrosis (CPPN) - 16 p., 32.7%, 3 - chronic calcifying pancreatitis (CCP) - 16 p., 32.7%. All cases of PDAC were pathologically proved. We calculated median of enhancement gradient between region of interest and intact parenchyma (М grad ) based on MSCT results. Pearson’s correlation coefficient (r p ) was calculated for correlation assessment. Results. We assessed mean М grad and mean serum FN rate in all three groups: PDAC - 28.1+2.6, р=0.0001, CPPN - 14.9+2.4, р=0.07, CCP - 13.3+0.7, р = 0.08 for М grad , and 239.8+30.1, p=0.8, 243.5+33.8, p=0.7, 227.2+34.3, p=0.8 for serum FN rate, respectively. There was statistically significant strong correlation of М grad in patients with PDAC (r p =0.63, p=0.0001). We revealed cut-off point of М grad value for PDAC that was 20 (p=0.001). There were no statistically significant correlations of serum FN rate in all groups (PDAC r p =0.04, p=0.8; CPPN r p =0.06, p=0.7; CCP r p = -0.03, p=0.8). Conclusion. Mgrad evaluation based on MSCT is an informative marker for differential diagnosis between PDAC and chronic pancreatitis, high rates of М grad positively correlate with PDAC existence. There was no correlation between serum FN rate and existence of PDAC, CPPN or CCP revealed.