Abstract
Background: The various diagnostic criteria for AIP differ in their emphasis on the need for ERP: the Japanese criteria mandate performance of ERP, the Korean criteria mandate either magnetic resonance pancreatogram or ERP and the Mayo Clinic HISORt criteria do not require either. The performance characteristics of ERP to diagnose AIP are unknown. Methods: ERPs (n=164) of AIP, chronic pancreatitis (CP) and pancreatic cancer (PaC) obtained from centers in USA, Japan and UK were screened for quality by an experienced endoscopist (MJL) unaware of clinical diagnoses. A final set of 48 pancreatograms (20 AIP, 10 CP, 10 PaC and 8 internal duplicates) arranged in random order were presented to 21 reviewers from North America (USA), Europe (UK) and Asia (Japan and S. Korea) who were unaware of clinical data or diagnoses. Reviewers noted presence or absence of key ERP features and provided their 3 most probable diagnoses given as % confidence (>95%, 75%, 50% and 25%), the total not exceeding 100%. We used a >75% confidence in the diagnosis of AIP to determine sensitivity and specificity for that condition. The Kappa statistic for inter-observer agreement between reviews was also calculated. Results: The specificity of ERP for AIP was high and similar at different centers (Table). However, its sensitivity for AIP varied widely. As a group, Asian readers had a significantly higher sensitivity for diagnosis of AIP (see table) and had a higher inter-observer agreement. The performance characteristics of ERP were not influenced by years of experience or specialty of reviewer (ERCPist, radiologist or pancreatologist). Conclusion: Ability to diagnose AIP based on ERP features alone varied widely in different countries. ERP had the highest sensitivity for AIP when interpreted by experts from Asia, where it is most often used to make the diagnosis of AIP. Highlighting features of AIP on ERP may improve diagnostic yield and reduce inter-observer variability in centers where ERP is not utilized as a diagnostic modality.
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