Integrated approach to the diagnosis of pancreatic carcinoma.

A prospective comparison of sensitivity, specificity and predictive value of ultrasonography (US), computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP) and angiography was performed in 112 patients with proven pancreatic carcinoma. ERCP had the highest sensitivity and specificity in evaluation of pancreatic carcinoma. CT was the least sensitive in detecting pancreatic malignancy. Angiography had the highest positive predictive value. US and ERCP had a high negative predictive value. The initial examination of a patient with suspected pancreatic carcinoma is by US. Should this produce an abnormal result, CT is then used to confirm a lesion. A diagnosis of unresectable pancreatic carcinoma could be made by US and CT without the need for additional imaging procedures. If not, ERCP is indicated when there is some distinct reason to suspect pancreatic carcinoma. If ERCP reveals an abnormality, then angiography is performed to determine whether the lesion is benign or malignant, and if malignant whether it is resectable or not.