Imaging modalities in the diagnosis of pancreatic adenocarcinoma: a systematic review and meta-analysis of sensitivity, specificity and diagnostic accuracy

Background Pancreatic cancer, primarily pancreatic ductal adenocarcinoma (PDAC), accounts for 2.4% of cancer diagnoses and 5.8% of cancer death annually. Early diagnoses can improve 5-year survival in PDAC. The aim of this systematic review was to determine the sensitivity, specificity and diagnostic accuracy values for MRI, CT, PET&PET/CT, EUS and transabdominal ultrasound (TAUS) in the diagnosis of PDAC. Methods A systematic review was undertaken to identify studies reporting sensitivity, specificity and/or diagnostic accuracy for the diagnosis of PDAC with MRI, CT, PET, EUS or TAUS. Proportional meta-analysis was performed for each modality. Results A total of 5399 patients, 3567 with PDAC, from 52 studies were included. The sensitivity, specificity and diagnostic accuracy were 93% (95% CI = 88–96), 89% (95% CI = 82–94) and 90% (95% CI = 86–94) for MRI; 90% (95% CI = 87–93), 87% (95% CI = 79–93) and 89% (95% CI = 85–93) for CT; 89% (95% CI = 85–93), 70% (95% CI = 54–84) and 84% (95% CI = 79–89) for PET; 91% (95% CI = 87–94), 86% (95% CI = 81–91) and 89% (95% CI = 87–92) for EUS; and 88% (95% CI = 86–90), 94% (95% CI = 87–98) and 91% (95% C = 87–93) for TAUS. Conclusion This review concludes all modalities, except for PET, are equivalent within 95% confidence intervals for the diagnosis of PDAC.