Summary of findings'. 'Imaging modalities for characterising focal pancreatic lesions.
| Name of test | Number of studies (number of participants) | Sensitivity (95% CI) | Specificity (95% CI) | Post‐test probability of positive test* (95% CI) | Post‐test probability of negative test* (95% CI) | Number of false positives per 100 positive index test results (95% CI) | Number of false negatives per 100 negative index test results (95% CI) | Risk of bias | Applicability concerns | Uncertainty (due to inconsistency or inability to assess inconsistency, and random errors because of overall small sample size) |
| Cancerous versus benign or precancerous (median pre‐test probability: 63%) | ||||||||||
| EUS‐FNA (cytology) | 1 (45) | 0.79 (0.60 to 0.91) | 1.00 (0.85 to 1.00) | 98% (79% to 100%) | 26% (14% to 43%) | 2 (0 to 21) | 26 (14 to 43) | Unclear | High | High |
| EUS‐FNA (CEA > 500 ng/mL) | 1 (24) | 0.93 (0.70 to 0.99) | 0.33 (0.12 to 0.65) | 70% (59% to 79%) | 25% (4% to 73%) | 30 (21 to 41) | 25 (4 to 73) | High | High | High |
| PET (criteria unspecified) | 1 (76) | 0.85 (0.73 to 0.92) | 0.91 (0.72 to 0.97) | 94% (81% to 98%) | 21% (12% to 34%) | 6 (2 to 19) | 21 (12 to 34) | Unclear | High | High |
| Cancerous versus benign (median pre‐test probability: 70%) | ||||||||||
| EUS | 2 (133) | 0.95 (0.84 to 0.99) | 0.53 (0.31 to 0.74) | 82% (74% to 88%) | 18% (6% to 45%) | 18 (12 to 26) | 18 (6 to 45) | Unclear or high | High | High |
| EUS‐FNA (cytology) | 3 (147) | 0.79 (0.07 to 1.00) | 1.00 (0.91 to 1.00) | 99% (90% to 100%) | 32% (2% to 92%) | 0 (0 to 9) | 32 (2 to 92) | High | High | High |
| PET (criteria unspecified) | 3 (99) | 0.92 (0.80 to 0.97) | 0.65 (0.39 to 0.85) | 86% (75% to 92%) | 22% (9% to 44%) | 14 (8 to 25) | 22 (9 to 44) | High | High | High |
| PET (SUVmax > 3.5) | 1 (80) | 0.96 (0.87 to 0.99) | 0.62 (0.43 to 0.78) | 85% (78% to 90%) | 12% (3% to 36%) | 15 (10 to 22) | 12 (3 to 36) | High | High | High |
| CT | 2 (123) | 0.98 (0.00 to 1.00) | 0.76 (0.02 to 1.00) | 90% (17% to 100%) | 6% (0% to 100%) | 10 (0 to 83) | 6 (0 to 100) | Unclear or high | High | High |
| MRI | 1 (29) | 0.80 (0.58 to 0.92) | 0.89 (0.57 to 0.98) | 94% (72% to 99%) | 34% (17% to 56%) | 6 (1 to 28) | 34 (17 to 56) | High | High | High |
| Precancerous or cancerous versus benign (median pre‐test probability: 71%) | ||||||||||
| EUS | 1 (34) | 0.92 (0.74 to 0.98) | 0.60 (0.31 to 0.83) | 85% (72% to 92%) | 25% (7% to 58%) | 15 (8 to 28) | 25 (7 to 58) | High | High | High |
| EUS‐FNA (cytology) | 2 (52) | 0.73 (0.01 to 1.00) | 0.94 (0.15 to 1.00) | 97% (25% to 100%) | 41% (1% to 98%) | 3 (0 to 75) | 41 (1 to 98) | Unclear or high | High | High |
| EUS‐FNA (CEA > 50 ng/mL) | 1 (11) | 0.29 (0.08 to 0.64) | 0.25 (0.05 to 0.70) | 48% (20% to 77%) | 87% (54% to 98%) | 52 (23 to 80) | 87 (54 to 98) | High | High | High |
| PET (SUVmax 2.4) | 1 (32) | 0.94 (0.74 to 0.99) | 0.93 (0.69 to 0.99) | 97% (83% to 100%) | 13% (2% to 49%) | 3 (0 to 17) | 13 (2 to 49) | High | High | High |
| CT | 1 (48) | 0.62 (0.45 to 0.76) | 0.64 (0.39 to 0.84) | 81% (66% to 90%) | 59% (44% to 72%) | 19 (10 to 34) | 59 (44 to 72) | Unclear | High | High |
| MRI | 1 (27) | 0.93 (0.69 to 0.99) | 0.85 (0.58 to 0.96) | 94% (80% to 98%) | 17% (3% to 58%) | 6 (2 to 20) | 17 (3 to 58) | High | High | High |
| Cancerous (invasive carcinoma) versus precancerous (dysplasia) (median pre‐test probability: 27%) | ||||||||||
| EUS | 5 (156) | 0.78 (0.45 to 0.94) | 0.91 (0.61 to 0.98) | 75% (37% to 94%) | 8% (3% to 22%) | 25 (6 to 63) | 8 (3 to 22) | Unclear or high | High | High |
| EUS‐FNA (cytology) | 3 (158) | 0.66 (0.03 to 0.99) | 0.92 (0.73 to 0.98) | 75% (29% to 95%) | 12% (1% to 69%) | 25 (5 to 71) | 12 (1 to 69) | Unclear or high | High | High |
| EUS‐FNA (CEA > 200 ng/mL) | 1 (41) | 1.00 (0.57 to 1.00) | 0.64 (0.48 to 0.78) | 51% (40% to 61%) | Not estimable | 49 (39 to 60) | Not estimable | High | High | High |
| CT | 6 (326) | 0.72 (0.50 to 0.87) | 0.92 (0.81 to 0.97) | 78% (57% to 91%) | 10% (5% to 18%) | 22 (9 to 43) | 10 (5 to 18) | Unclear or high | High | High |
| MRI | 1 (32) | 0.75 (0.30 to 0.95) | 0.93 (0.77 to 0.98) | 80% (48% to 94%) | 9% (2% to 35%) | 20 (6 to 52) | 9 (2 to 35) | High | High | High |
| Cancerous (high‐grade dysplasia or invasive carcinoma) versus precancerous (low‐ or intermediate‐grade dysplasia) (median pre‐test probability: 45%) | ||||||||||
| EUS | 4 (196) | 0.86 (0.74 to 0.92) | 0.91 (0.83 to 0.96) | 89% (80% to 94%) | 11% (7% to 19%) | 11 (6 to 20) | 11 (7 to 19) | High | High | High |
| EUS‐FNA (cytology) | 3 (310) | 0.47 (0.24 to 0.70) | 0.91 (0.32 to 1.00) | 81% (19% to 99%) | 32% (22% to 45%) | 19 (1 to 81) | 32 (22 to 45) | Unclear or high | High | High |
| EUS‐FNA (CEA > 200 ng/mL) | 3 (160) | 0.58 (0.28 to 0.83) | 0.51 (0.19 to 0.81) | 49% (28% to 70%) | 40% (19% to 65%) | 51 (30 to 72) | 40 (19 to 65) | High | High | High |
| EUS‐FNA (CA 19‐9 > 1000 U/mL) | 1 (41) | 0.90 (0.60 to 0.98) | 0.42 (0.26 to 0.59) | 56% (47% to 65%) | 16% (3% to 57%) | 44 (35 to 53) | 16 (3 to 57) | High | High | High |
| EUS‐FNA (CEA > 692.8 ng/mL) | 1 (20) | 0.80 (0.49 to 0.94) | 0.90 (0.60 to 0.98) | 87% (50% to 98%) | 15% (5% to 39%) | 13 (2 to 50) | 15 (5 to 39) | Unclear | High | High |
| PET (SUVmax > 2 to 2.5) | 4 (124) | 0.90 (0.79 to 0.96) | 0.94 (0.81 to 0.99) | 93% (78% to 98%) | 8% (4% to 16%) | 7 (2 to 22) | 8 (4 to 16) | High | High | High |
| CT | 3 (139) | 0.87 (0.00 to 1.00) | 0.96 (0.00 to 1.00) | 95% (0% to 100%) | 10% (0% to 100%) | 5 (0 to 100) | 10 (0 to 100) | Unclear or high | High | High |
| MRI | 3 (189) | 0.69 (0.44 to 0.86) | 0.93 (0.43 to 1.00) | 89% (35% to 99%) | 21% (12% to 36%) | 11 (1 to 65) | 21 (12 to 36) | High | High | High |
| Cancerous (invasive carcinoma) versus precancerous (low‐grade dysplasia) (median pre‐test probability: 21%) | ||||||||||
| EUS | 1 (51) | 0.77 (0.50 to 0.92) | 0.89 (0.76 to 0.96) | 67% (43% to 84%) | 7% (3% to 16%) | 33 (16 to 57) | 7 (3 to 16) | Unclear | High | High |
| CT | 1 (46) | 0.50 (0.22 to 0.78) | 0.95 (0.83 to 0.99) | 72% (36% to 92%) | 13% (7% to 22%) | 28 (8 to 64) | 13 (7 to 22) | High | High | High |
| Precancerous or cancerous (intermediate‐ or high‐grade dysplasia or invasive carcinoma) versus precancerous (low‐grade dysplasia) (median pre‐test probability: 59%) | ||||||||||
| CT | 3 (106) | 0.83 (0.68 to 0.92) | 0.83 (0.64 to 0.93) | 89% (56% to 98%) | 33% (18% to 52%) | 11 (2 to 44) | 33 (18 to 52) | High | High | High |
| MRI | 2 (71) | 0.80 (0.58 to 0.92) | 0.81 (0.53 to 0.95) | 86% (67% to 95%) | 27% (13% to 47%) | 14 (5 to 33) | 27 (13 to 47) | High | High | High |
| Precancerous or cancerous (intermediate‐ or high‐grade dysplasia or invasive carcinoma) versus precancerous (low‐grade dysplasia) or benign (median pre‐test probability: 43%) | ||||||||||
| EUS | 1 (70) | 0.97 (0.83 to 0.99) | 0.40 (0.26 to 0.55) | 55% (48% to 61%) | 6% (1% to 31%) | 45 (39 to 52) | 6 (1 to 31) | High | High | High |
*Post‐test probability was calculated at the median pre‐test probability.
Abbreviations:
CA 19‐9: carbohydrate antigen 19‐9 CEA: carcinoembryonic antigen CI: confidence interval CT: computed tomography EUS: endoscopic ultrasound FNA: fine‐needle aspiration MRI: magnetic resonance imaging PET: positron emission tomography SUVmax: maximum standardised uptake values