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Preoperative Diagnosis of Pancreatic Cystic Lesions

The Accuracy of Endoscopic Ultrasound and Cross-Sectional Imaging

Jang, Dong Kee MD*; Song, Byeong Jun MD; Ryu, Ji Kon MD, PhD*; Chung, Kwang Hyun MD*; Lee, Ban Seok MD*; Park, Joo Kyung MD*; Lee, Sang Hyub MD, PhD*; Kim, Yong-Tae MD, PhD*; Lee, Jae Young MD, PhD

doi: 10.1097/MPA.0000000000000396
Original Articles

Objective This study aimed to evaluate the accuracy of endoscopic ultrasound (EUS) and cross-sectional imaging including multidetector computed tomography (MDCT) or magnetic resonance imaging (MRI) as a preoperative diagnostic modality for the pancreatic cystic lesions.

Methods Three hundred eighteen patients with surgically proven pancreatic cystic lesions were enrolled as a study cohort from 1998 to 2011. Preoperative radiological, EUS, and final histopathologic diagnosis were correlated to measure several kinds of diagnostic performance.

Results A total of 318 patients underwent preoperative MDCT, with additional imaging modalities such MRI and/or EUS in 215 (67.6%) and 108 (34.0%) patients, respectively. κ Values among the different modalities were as follows: MDCT versus pathology = 0.52 (P < 0.0001), MDCT + MRI versus pathology = 0.674 (P < 0.0001), and EUS versus pathology = 0.558 (P < 0.0001). The sensitivity and specificity in terms of ability to predict neoplastic cysts were as follows: MDCT, 83.1%/70.0%; MDCT + MRI, 94.7%/58.7%; and EUS, 88.5%/52.9%. The diagnostic accuracies of MDCT and MDCT + MRI were 61.4% (62/101) and 80.5% (173/215), respectively, and that of EUS was 70.4% (76/108).

Conclusions Magnetic resonance imaging as an additional diagnostic modality to MDCT increased the accuracy, sensitivity, and specificity, as well in terms of predicting neoplastic cysts.

From the *Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul; †Department of Internal Medicine, Seonam University Myongji Hospital, Goyang-si, Gyeonggi-do; and ‡Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.

Received for publication June 16, 2014; accepted January 28, 2015.

Reprints: Ji Kon Ryu, MD, PhD, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul 110-744, Korea (e-mail:

The authors declare no conflict of interest.

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