Is pancreatogram interpretation reliable? - a study of observer variation and error

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Abstract
Observer variation in the interpretation of endoscopic pancreatograms was examined by asking 4 experienced observers to assess 40 sets of well-documented radiographs (from 20 patients with cancer and 20 with pancreatitis), both without (blind) and with clinical details, each on 3 occasions. Individual consistency for blind diagnoses ranged from 61-78%, increasing significantly with clinical information. Overall diagnostic accuracy with clinical information varied from 52-83% for cancer, and from 87-95% for pancreatitis. Unanimous and correct opinions were given by the 4 observers for only 53% of all cases, even when clinical details were provided. Clinical information changed the radiographic diagnosis in 43% of assessments, 83% of these changes leading to improved accuracy. ERCP [endoscopic retrograde cholangiopancreatography] gives direct information about the major pancreatic and biliary duct systems and often provides an accurate diagnosis. Caution must be exercised in relying upon radiological appearances alone.