Diagnostic Strategy for Differentiating Autoimmune Pancreatitis From Pancreatic Cancer: Is an Endoscopic Retrograde Pancreatography Essential

Pancreas, 05/04/2012

In patients with suspected autoimmune pancreatitis (AIP), the decision to perform endoscopic retrograde pancreatography (ERP could be tailored to findings on computed tomography (CT).

Methods

  • Eighty-four AIP patients and 73 pathology-proven pancreatic cancer patients from a prospectively maintained database were retrospectively included.
  • Computed tomography and ERP images were reviewed in consensus by 2 blinded radiologists.
  • The diagnostic performance of CT alone and combined use of CT and ERP (CT-ERP) were compared.

Results

  • The area under the receiver operating characteristic curve of CT-ERP was significantly greater than that of CT alone (0.97 vs 0.87, P < 0.001).
  • When patients with AIP were divided into 2 subgroups according to CT features (typical vs atypical), 24 (69%) of 35 AIP patients with atypical CT findings were correctly diagnosed with AIP at CT-ERP and received benefits from additional ERP.
  • Endoscopic retrograde pancreatography had little added benefit in patients with typical CT findings for AIP (n = 49), because no alternative diagnoses were established after ERP.

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