Table 3.
Section III results: diagnosis
| Median (IQR) | Agreement (%) | Result | |
|---|---|---|---|
| 10. The standard diagnostic procedure should include first steps anamnesis, physical examination, analytical and ultrasound tests | 9 (8–9) | 91.0 | First round agreement |
| 11. When the ultrasound request specifies that it is intended to rule out pancreatic cancer, if it is not diagnostic (for lack of visualization or for other reasons) there must be a protocol that leads directly to the performance of an MCT scan | 9 (8–9) | 97.8 | First round agreement |
| 12. The availability and speed to obtain complementary examinations, and specifically the ultrasound, differ in different places, and the approach of the primary care physician must be decided accordingly | 8 (7–9) | 79.8 | First round agreement |
| 13. In primary care, if the availability of explorations is limited, when there is presence jaundice or acute pain that causes suspicion of pancreatitis, the patient can be referred to the Emergency Unit to perform diagnostic tests on an urgent basis | 9 (8–9) | 92.1 | First round agreement |
| 14. When there is a substantial delay in the performance of ultrasound, while on primary care, the request should specify a suspicion of pancreatic cancer, which should ensure a prompt scanning by the diagnostic imaging service | 8 (8–9) | 94.4 | First round agreement |
| 15. Ultrasound has a low sensitivity and detects tumors with a resolution of 2 cm so that most small tumors are not detected. However, in general, it must be performed before moving towards other tests since it does detect advanced tumors and/or with liver metastases | 8 (6–9) | 71.9 | First round agreement |
| 16. Negative ultrasound results do not rule out pancreatic cancer. If the symptoms are sufficiently indicative of this diagnosis, the patient should be referred to the specialist for a MCT scan | 9 (8–9) | 96.6 | First round agreement |
| 17. Suspected cases while in primary care should be referred to a hospital with interdisciplinary tumor committees with experience in the diagnosis and treatment of pancreatic cancer | 9 (7–9) | 82.0 | First round agreement |
| 18. Regardless of how the diagnosis has been made (ultrasound or MCT) and in what type of unit it is carried, every patient with pancreatic cancer should be given an MCT with a specific protocol to assess the relationship of the tumor with the mesenteric vessels and to assess its resectability | 9 (9–9) | 97.8 | First round agreement |
| 19. Upon suspicion of pancreatic cancer, the diagnostic study of the specialized unit should be completed within 2 weeks | 9 (8–9) | 94.4 | First round agreement |
| 20. Histological confirmation of the diagnosis should always be obtained, with the exception of surgical cases in which histological examination will be performed with operative samples | 8 (7–9) | 85.4 | First round agreement |
| 21. Each reference center should establish a multidisciplinary tumor committee (MDC) to which all patients are presented | 9 (8.5–9) | 97.8 | First round agreement |
IQR interquartile range