Original article The predictive value of mean platelet volume in differential diagnosis of non-functional pancreatic neuroendocrine tumors from pancreatic adenocarcinomas Kerem Karaman a , Erdal Birol Bostanci a , Erol Aksoy a , Mevlut Kurt b, ⁎, Bahadır Celep a , Murat Ulas a , Tahsin Dalgic a , Ali Surmelioglu a , Mutlu Hayran c , Musa Akoglu b a Department of Gastroenterological Surgery, Turkiye Yuksek Ihtisas Teaching and Research Hospital, Ankara, Turkey b Department of Gastroenterology, Turkiye Yuksek Ihtisas Teaching and Research Hospital, Ankara, Turkey c Institute of Oncology, Department of Preventive Oncology, Hacettepe University, Faculty of Medicine, Turkey abstract article info Article history: Received 13 January 2011 Received in revised form 18 March 2011 Accepted 17 April 2011 Available online 12 June 2011 Keywords: Pancreas adenocarcinoma Neuroendocrine tumor Mean platelet volume CA19–9 Objective: The aim of the present study is to evaluate in a retrospective manner the diagnostic value of mean platelet volume (MPV) in pancreatic adenocarcinomas and pancreatic neuroendocrine tumors (PNETs). Patients and methods: A total of 92 patients, who were admitted for pancreatic adenocarcinoma (n = 76) and PNET (n = 16) between March 2007 and December 2009, were analyzed retrospectively for demographics and clinical information. Results: Thirty-nine patients (51.3%) had a resectable, whereas 37 patients (48.7%) had an unresectable pancreatic adenocarcinoma. Nine patients (56.3%) had a non-functional PNET, 6 patients (37.5%) had an insulinoma, and the remaining one patient had a gastrinoma. The mean age was 59.3 ± 10.5 for pancreatic adenocarcinomas and 45.1 ± 10.6 for PNETs. The mean age at diagnosis was significantly higher in patients with pancreatic adenocarcinomas than the patients with PNET (p b 0.001). Preoperative mean hemoglobin levels were significantly lower in patients with pancreatic adenocarcinoma than those with PNET (12.4 ± 1.8 g/dl vs 13.7 ± 2.2 g/dl), (p b 0.013). The preoperative median MPV levels were significantly lower in patients with PNET 7.8 fL (7.2–9.4) than in patients with pancreatic adenocarcinomas 8.6 fL (6.6–13.5), (p b 0.014). In subgroup analysis, a significant difference in MPV levels was mainly caused by the difference between pancreatic adenocarcinomas and non-functional PNETs (p = 0.017). The cut-off value of MPV level for detection of PNETs was calculated as ≤ 7.8 fL using ROC analysis [Sensitivity: 66.7%, specificity: 75.9%, AUC: 0.734 (0.587–0.880) p = 0.022]. In logistic regression analysis, independent predictive factors for determining PNETs in the differential diagnosis of pancreatic adenocarcinomas were calculated as age (OR = 0.068, 95% CI: 0.012–0.398), Ca 19–9 (OR = 0.039, 95% CI: 0.006–0.263), MPV (OR = 0.595, 95% CI: 0.243–1.458), and hemoglobin (OR = 1.317, 95% CI: 0.831–2.086). Conclusion: Age, Ca 19–9, MPV, and hemoglobin levels have diagnostic value for distinguishing PNETs from pancreatic adenocarcinomas. © 2011 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. 1. Introduction Pancreatic cancer is the fourth leading cause of cancer death in Western countries [1]. Poor prognosis is related to the stage of the tumor which may preclude surgical resection. Therefore, surgery remains the sole curative treatment modality and earlier detection of potentially resectable disease may result in improved patient survival [2]. Advances in radio-diagnostic methods such as multi-detector computerized tomography (MD-CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography (ERCP), and more recently endoscopic ultrasonography (EUS) and positron emission computerized tomography (PET-CT) have produced high- quality images of the pancreas, which facilitate the detection and characterization of focal pancreatic lesions [3–7]. However, pancreatic neuroendocrine tumors (PNETs), especially non-functional PNETs may pose dilemmas in diagnosis, localization and treatment [8]. Although these tumors tend to be less aggressive than their adenocarcinoma counterpart, they frequently metastasize to the liver [9]. This is important for treatment planning, because liver metastasis is considered to be a criterion of unresectability for pancreatic adenocarcinomas but not for PNETs. European Journal of Internal Medicine 22 (2011) e95–e98 ⁎ Corresponding author at: Turkiye Yuksek Ihtisas Teaching and Research Hospital, Department of Gastroenterology, Kizilay Sok. No:2, Sihhiye, Ankara, Turkey. Tel.: + 90 505 2762812; fax: +90 312 3124120. E-mail address: dr.mevlutkurt@gmail.com (M. Kurt). 0953-6205/$ – see front matter © 2011 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.ejim.2011.04.005 Contents lists available at ScienceDirect European Journal of Internal Medicine journal homepage: www.elsevier.com/locate/ejim