Endoscopy 2006; 39 - TH17
DOI: 10.1055/s-2006-947672

Comparison of the diagnostic accuracy of EUS, MDCT, MRCP and ERCP in intraductal papillary mucinous neoplasm (IPMN) of the pancreas

H Imazu 1, Y Uchiyama 1, H Kakutani 1, K Goda 1, S Omar 2, M Kawamura 1, H Tajiri 3
  • 1Dept. of Endoscopy, The Jikei University School of Medicine, Tokyo, JP
  • 2Dept. of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, DE
  • 3Division of Gastroenterology and Hepatology, The Jikei University School of Medicine, Tokyo, JP

Background: Multidiagnostic imaging consisting of EUS, MDCT, MRCP and ERCP are utilised for diagnosing IPMN. The diameter of main pancreatic duct (MPD), size of cystic lesions and mural nodules are very important factors in determining further management for patients with IPMN. However, the role of each diagnostic modality has yet to be defined. We investigated the diagnostic ability of EUS, MDCT, MRCP and ERCP for detection of IPMN.

Methods: Eighty patients suspected to have pancreatic tumour by transabdominal US and/or serological tumour maker were recruited from January 2003 to December 2005 and received EUS (Olympus GF UCT240-AL5, GF-UM2000), MDCT, MRCP and ERCP. Reviewers were blinded to findings of recorded images/video of each different imaging modality. Accuracy of EUS, MDCT and MRCP for detecting IPMN was compared to characteristic findings of ERCP as the reference standard.

Results: IPMN were diagnosed in 20 patients with ERCP. Of the remaining 60 patients, pancreatic cancer was diagnosed in 41, chronic pancreatitis in 7 and others in 12. The sensitivity and specificity in diagnosing IPMN for the 80 patients were as follows: 100%/98.3% for EUS, 65%/97% for MDCT, and 85%/95% for MRCP (sensitivity of EUS vs. MDCT, p<0.05). The sensitivity and specificity in accurately measuring dilated MPD of more than 7mm and cystic lesions of more than 30mm in diameter in the 20 patients with IPMN were as follows: 100/100/80/100% for EUS, 50/94/40/80% for MDCT and 75/100/45/67% for MRCP (p=N.S). 4 patients underwent surgical resection, and mural nodule was accurately demonstrated by EUS and ERCP before resection.

Conclusion: EUS was very useful in the initial evaluation of patients suspected to have IPMN. In addition, EUS provided clear images of pancreatic duct, cystic lesions and mural nodules for determining further management in IPMN. ERCP might be now unnecessary for diagnosing IPMN.