Good Agreement Between Transabdominal and Endoscopic Ultrasound of the Pancreas in Chronic Pancreatitis

Abstract

Purpose We aimed to evaluate the agreement of single criteria and dedicated scores from transabdominal ultrasound of the pancreas (US) compared to standards by endoscopic ultrasound (EUS) and computed tomography (CT).

Materials and Methods In this observational cohort study performed in a tertiary care center, US and EUS were performed in 110 patients referred for suspected CP. Based on the Mayo score, 52 patients were diagnosed with CP. The sonographic findings obtained by both methods were registered. The number of criteria was counted and scored according to the Rosemont score.

Results Agreement between the number of detected US and EUS criteria was substantial (ICC = 0.74 [0.61–0.83]. Adding Rosemont weighting improved the agreement (ICC = 0.88 [0.81–0.92]). Regarding individual criteria, the agreement was substantial for the detection of calcifications (κ = 0.86) and moderate for cysts and irregular or dilated pancreatic duct (κ = 0.42–0.58). Agreement for the other criteria was poorer (κ≤ 0.40). The diagnostic performance indices [95 % CI] of US for diagnosing CP (using Mayo score as reference standard) were for the unweighted score: Sensitivity: 0.65 [0.51–0.78], specificity: 0.97 [0.87–1.00]; and for Rosemont score: Sensitivity: 0.75 [0.61–0.86], specificity: 0.95 [0.83–0.99].

Conclusion The agreement between US and EUS for the unweighted and weighted scores was substantial. For the features calcifications, cysts and main pancreatic duct (MPD) changes, agreement was moderate to substantial. For the other detected US criteria, the agreement with EUS was too poor to be clinically relevant.

Zusammenfassung

Ziel Das Ziel bestand darin, die Übereinstimmung von Einzelkriterien und dedizierten Scores des transabdominalen Ultraschalls der Bauchspeicheldrüse (US) im Vergleich zu den Standards des endoskopischen Ultraschalls (EUS) und der Computertomografie (CT) zu bewerten.

Materialien und Methoden In dieser Beobachtungsstudie, die in einem tertiären Versorgungszentrum durchgeführt wurde, wurde bei 110 Patienten mit Verdacht auf chronische Pankreatitis (CP) US und EUS durchgeführt. Basierend auf dem Mayo-Score wurde bei 52 Patienten eine CP diagnostiziert. Die mit beiden Methoden erhobenen sonografischen Befunde wurden erfasst. Die Anzahl der Kriterien wurde bestimmt und mittels Rosemont-Score bewertet.

Ergebnisse Die Übereinstimmung zwischen der Anzahl der festgestellten US- und EUS- Kriterien war beträchtlich (ICC = 0,74 [0,61–0,83]. Durch die zusätzliche Rosemont-Gewichtung verbesserte sich die Übereinstimmung (ICC = 0,88 [0,81–0,92]). In Bezug auf die Einzelkriterien war die Übereinstimmung für den Nachweis von Verkalkungen beträchtlich (κ = 0,86) und von Zysten und eines irregulären oder dilatierten Pankreasgangs moderat (κ = 0,42–0,58). Die Übereinstimmung bezüglich der übrigen Kriterien war schlechter (κ ≤ 0,40). Die diagnostischen Leistungsindizes [95 % CI] des US für die Diagnose einer CP (mit Mayo-Score als Referenzstandard) betrugen für den ungewichteten Score: Sensitivität: 0,65 [0,51–0,78], Spezifität: 0,97 [0,87–1,00] und für den Rosemont-Score: Sensitivität: 0,75 [0,61–0,86], Spezifität: 0.95 [0.83–0.99].

Schlussfolgerung Die Übereinstimmung zwischen US und EUS bei den ungewichteten und gewichteten Scores war erheblich. Für die Merkmale Verkalkungen, Zysten und Veränderungen des Pankreashauptganges (MPD) war die Übereinstimmung moderat bis beträchtlich. Für die anderen festgestellten US-Kriterien, war die Übereinstimmung zu schlecht, um klinisch relevant zu sein.

Key words

pancreas - transabdominal ultrasound - endoscopic ultrasound - diagnostic accuracy - chronic pancreatitis

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