Recognizing intrapancreatic accessory spleen via EUS: Interobserver variability.

Area of Science:

• Gastroenterology
• Diagnostic Imaging
• Pathology

Background:

• Accessory spleen (AS) can appear as an intrapancreatic lesion on endoscopic ultrasound (EUS).
• This appearance can mimic other pancreatic pathologies, potentially leading to unnecessary interventions.
• Accurate differentiation of intrapancreatic accessory spleen (IPAS) is crucial.

Purpose of the Study:

• To evaluate the diagnostic accuracy of EUS in distinguishing intrapancreatic accessory spleen (IPAS) from other pancreatic lesions.
• To assess the interobserver agreement among endosonographers in identifying IPAS.

Main Methods:

• Ten endosonographers reviewed twelve sets of endoscopic images of spleen and pancreatic lesions.
• Lesions were confirmed by histology or cytology.
• Interobserver agreement was analyzed using Gwet's coefficient statistic.

Main Results:

• Interobserver agreement for identifying IPAS was fair (0.37).
• EUS sensitivity for IPAS was 77%, specificity 74%, PPV 50%, and NPV 92%.
• Moderate-to-substantial agreement existed for describing lesion characteristics, but not for IPAS diagnosis itself.

Conclusions:

• EUS criteria alone are insufficient for accurate IPAS diagnosis.
• The similar sonographic appearance of IPAS and pancreatic neuroendocrine tumors can lead to diagnostic confusion.
• Fine-needle aspiration (FNA) may be necessary for confirming IPAS diagnosis.