Pancreatic cancer detection with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography: a prospective controlled study

Summary

Background

Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive and increasingly used procedure in cases involving biliary and pancreatic diseases. However, the accuracy of MRCP in differential diagnosis between pancreatic cancer and chronic pancreatitis has never been documented in a large prospective controlled study.

Methods

124 patients were recruited for the study, selected from 141 consecutive patients with an average age of 55 years (range 19–80) who presented to our department between February, 1996, and January, 1998, with a strong clinical suspicion of pancreatic cancer. MRCP images were interpreted by a radiologist and a gastroenterologist who were unaware of the clinical diagnosis of patients. The exact diagnosis was based upon histological evidence from biopsy examination (surgical and fine needle biopsy) or a follow-up of at least 12 months.

Findings

Of the 124 patients, 37 (30%) had pancreatic carcinoma; 17 (14%) had other neoplastic pancreatic diseases; 57 (46%) had chronic pancreatitis; 13 (10%) pancreatic ducts were clear. The sensitivity of MRCP with respect to diagnosing pancreatic cancer was 84% and its specificity 97%. The corresponding values for endoscopic retrograde cholangiopancreatography (ERCP) were 70% and 94%, respectively.

Interpretation

MRCP is as sensitive as ERCP when detecting pancreatic carcinomas. Furthermore, it is feasible to presume that the use of MRCP may prevent inappropriate explorations of the pancreatic and common bileducts in cases of suspected pancreatic carcinomas, where interventional endoscopic therapy (ie, palliative common-bileduct drainage) is unlikely.

Introduction

The diagnosis of pancreatic cancer and chronic pancreatitis is notoriously problematic, in that both diseases may have unspecific clinical symptoms. Even on the basis of imaging criteria (percutaneous or endoscopic ultrasound, endoscopic retrograde cholangio-pancreatography, and computed tomography) and molecular techniques chronic pancreatitis sometimes remains difficult to distinguish from pancreatic cancer.1, 2 The therapeutic advantages of an early diagnosis are obvious and indicate the need for a noninvasive, highly sensitive, and specific method—one that can discriminate between benign and neoplastic pancreatic lesions.

Magnetic resonance cholangiopancreatography (MRCP) is an abdominal magnetic resonance imaging (MRI) procedure, in which the biliary and pancreatic ducts can be visualised without contrast material.3, 4, 5 Several groups have reported favourable results with MRCP to evaluate a variety of common-bileduct diseases.6, 7 However, no prospective controlled studies have used MRCP in an attempt to distinguish chronic pancreatitis from pancreatic carcinoma.

The aim of this current study is to prospectively assess the diagnostic value of MRCP to diagnose pancreatic cancer compared with histopathological evidence or a follow-up examination of at least 12 months.