Comprehensive review of diagnostic modalities for early chronic pancreatitis

Table 2 Comparisons of diagnostic modalities

Modality	Diagnostic standards	Sensitivity	Specificity
Aetiology	TIGAR-O classification (version 2)[13].	-	-
Clinical presentation	Three or more of the following features: Abnormal serum or urine pancreatic enzyme concentrations; continuous heavy alcohol consumption (> 80 g alcohol/day or more than 5 drinks/day), family history of hereditary chronic pancreatitis, or known sporadic high-risk mutations; recurring epigastric abdominal pain; and abnormal exocrine function. Genetic pancreatitis should be suspected in young patients with clinical presentations but without a history of risk factors.	-	-
TA-US	Irregular main pancreatic duct with a diameter > 3 mm, hyperechoic pancreatic duct wall, or lobularity with stranding.	69% (95%CI: 54-80)	94%(95%CI: 90-100)
CT	Two or more of the following features: MPD within 2-4 mm; mild organ enlargement; irregular main pancreatic duct with ≥ 3 pathological side branches; pseudocysts ≤ 10 mm; and heterogeneous parenchyma.	75% (95%CI: 66-83)	91%(95%CI: 81-96)
MRI/MRCP	Two or more of the following features: MPD 2-4 mm; mild organ enlargement; irregular main pancreatic duct with ≥ 3 pathological side branches; pseudocysts ≤ 10 mm; and heterogeneous parenchyma.	Single-parametric: 77%; Multi-parametric: 91%	Single-parametric: 83%; Multi-parametric: 86%
ERCP	More than three pathological side branches plus a normal MPD.	82% (95% CI: 76-87)	94% (95% CI: 87-98)
EUS	More than two of the following seven criteria, including at least one of criteria 1-4: (1) Stranding; (2) Hyperechoic foci without shadowing; (3) Lobularity with honeycombing; (4) Lobularity without honeycombing; (5) Cysts; (6) Dilated side branches; (7) Hyperechoic main pancreatic duct margin.	61% (non-fibrosis); 84% (for fibrosis)	75% (non-fibrosis); 100% (for fibrosis)
EUS-EG	A strain ratio of > 10 or a mean strain histogram value of < 50 was associated with malignancy.The mean value can be used to diagnose mild or higher-grade fibrosis.	76.4%	91.7%
FE-1	Moderate EPI can be diagnosed based on an abnormal FE-1 level of < 200 μg/g, which has a high false-positive rate.	76.5%; 45.0% (mild ductal changes and insufficiency)	86.0%
ePFT	Peak bicarbonate concentration of < 80 mmol/L is considered abnormal and correlated with early fibrosis.	86% (95%CI: 67-100)	67% (95%CI: 13-100)
FNA	Ruling out malignancy and staging of CP. CEA testing: Cut-off value of 192 ng/mL. Molecular analysis: KRAS and GNAS mutations.	85% (pancreatic cancer)	98% (pancreatic cancer)
nCLE	A complementary modality for detecting subtle changes in early CP and helpful for distinguishing malignancies.	94.3% (cystic lesions); 90.3% (PDAC)	98.1% (cystic lesions); 89.5% (PDAC)

Sen: Sensitivity; Spec: Specificity; TA-US: Transabdominal ultrasound; MPD: Main pancreatic duct; CT: Computed tomography; MRI: Magnetic resonance imaging; EUS: Endoscopic ultrasound; EUS-EG: Endoscopic ultrasound elastography; FE-1: Faecal elastase-1; ePFT: Endoscopic pancreatic function test; nCLE: Endoscopic pancreatic function test; EPI: Exocrine pancreatic insufficiency; CP: Chronic pancreatitis; CEA: Carcinoembryonic antigen; MRCP: Magnetic resonance cholangiopancreatography; ERCP: Endoscopic retrograde cholangiopancreatography; FNA: Fine-needle aspiration; PDAC: Pancreatic ductal adenocarcinoma; AIP: Autoimmune pancreatitis; AP: acute pancreatitis; RAP: Recurrent acute pancreatitis; CKD: Chronic kidney disease; NCCP: Non-calcific chronic pancreatitis; ROC: Receiver operating characteristic; ROI: Region of interest; SD: Standard deviation; SR: Strain ratio.