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

Observer variation in the interpretation of endoscopic pancreatograms has been examined by asking four 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 three occasions. Individual consistency for "blind" diagnoses ranged from 61% to 78%, increasing significantly with clinical information. Overall diagnostic accuracy with clinical information varied from 52% to 83% for cancer, and from 87% to 95% for pancreatitis. However, unanimous and correct opinions were given by the four 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 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.