Should I get a 2nd opinion on MRCP interpretation or not?

Forgot to add both MRI was with contrast done at South CA kaiser
I’m 64 year old woman

@lpaelevated4 In my opinion, as a patient who has had a total pancreactectomy due to multiple Neuroendocrine Tumors, you should seek an additional opinion from a reputable HPB (Hepato-Pancreato-Biliary) surgeon. I would see them sooner because it is obvious you are anxious to be reassured that all is stable. Additionally, someone else may have a different idea about pursuing more regular imaging to provide additional data points to ascertain if this "burst" in growth is just an anomaly or it is indicative of something that needs more immediate addressing.

Based upon your history and your mother's, you may also want to consult with a geneticist to ascertain if you have a genetic predisposition to certain conditions. This diagnosis will help steer you and your physicians in the right direction for any future treatments. (You may have to pay for these tests in some cases, not breast cancer probably, but health insurers haven't gotten their act together about other genetic conditions yet.) I found out that I have MEN1, after they found the pancreatic tumors. This has led me to see multiple specialists and have subsequent routine imaging, monitoring, and surgeries. All of which have helped me to extend my life and improve my outcome.

Of note, diagnostic MRI equipment can vary in its ability to show phenomena (lesions/cyst) from facility to facility and differing MRI units within a hospital campus. From what little I know, you could have had a small (2mm, maybe even a 5mm) cyst that was not identifiable in 2023 based upon the ability of the equipment or the slices that were imaged. One of my surgeons explained it to me that it is like slicing raisin bread. One year a scan will not show anything and the next it may show a 2 mm lesion because the slice was in the middle of the lesion "raisin" during the recent scan. Does that help you to visualize the problem? As a result, this may not have grown as much as you believe.

The MRCP may help give them additional information from a different methodology. I get contrast CT/PET-Dotatate and alternating MRI's yearly to look for new NETs. The contrast they use is one that NET's like and absorb, thereby showing prominently in the scan. I'm not sure what they would use to identify an IPMN, but this might help you to research and be able to ask additional questions about your testing.

PANCAN is the Pancreatic Cancer Action Network online, and is a great resource for information as well as specialists in your area that may be able to help. https://pancan.org/

Try not to be afraid. Educate yourself and if what you hear doesn't make sense, vote with your feet and see someone else. Trust your gut. It does help to have someone with you during all of your visits who can write down notes based upon your list of questions and the information the doctors give. When you go back over the notes later, it helps with research. When you face the office visits alone, you cannot listen and absorb everything at the same time, especially if you are scared.

We are here to help. Please let me know if you have other questions I may have some insights into based upon my experiences.

- Matt

Had an incidental finding on pancreatic cyst of 1.3 cm and had an MRCP this morning and received the test results in the afternoon:
Radiologist did not report much on my pancreas except for:
Cystic focus measuring 13 mm in the body (2-15) previously 9 mm on CT dated 1/31/2023. No mural modularity . No main pancreatic dilation.
Recommendation to consider follow up in 2 years or GI MD advice if further clarification is necessary . If stable at 2 years, consider lengthening follow up interval to 3 years and then to 5 years for total of 10 years if clinically appropriate.

Radiologist does not state what type of pancreatic cyst. Is it benign, is it on side branch of IPMN? He never stated what the characteristics of the pancreatic cyst.

Should I ask Kaiser GP for a 2nd opinion on the reading as it basically state that the pancreatic cyst is not malignant but nothing to state it is benign or precancerous?
Does it seem like there should be more information on the report?
Does it seem like to have follow up in 2 years is good enough?

Thanks

I was diagnosed with pancreatic cancer at Kaiser in 2016.

If I were you, I would first request an appointment with your GP and ask for an explanation of the radiologist's report. If you are not satisfied, you can readily switch to another GP. You could ask for a referral to a gastroenterologist (the report you received mentions possible advice from a gastroenterologist).

I went to a Kaiser emergency room to accelerate my diagnosis. A friend also did this. It helped both of us.

I sought opinions outside Kaiser at a few points, but I had to pay for them.

Good luck.

@castell Did you call to request for the MRI imaging and then paid for a radiologist to read the image? Was it expensive? Did you request a 2nd opinion from Kaiser or you didn't care to?

@lpaelevated4
My first sign of something wrong was abnormal results in routine blood work -- my liver function tests were way off. My Kaiser GP referred me to a liver specialist: he could see some faint jaundice in my eyes, and he ordered an MRCP.

Results of the MRCP revealed that I had pancreatic cancer. All this was in Kaiser.

Hello, I also had a Pancreatic cyst incidental finding in early 2024 which was detected in a contrast CT. My GP highly recommended I follow up with a contract MRI which revealed the presence of 2.9 cm, Mucinous cyst, main duct dilation IPMN, and a history of acute pancreatitis. These are considered worrisome features for possible pancreatic cancer. Shortly thereafter, I had a biopsy of my cyst which revealed high grade atypia, I met with my GI to go over my test results and based on all the worrisome features found through testing, I was referred to surgical oncology. In June of 2024, I had a Whipple surgery in which it was found that my cyst did indeed have cells of the adenocarcinoma type (Stage 1A). It is my understanding that oncologist doctors follow a criteria based on the results of the tests for probability of cancer and to deem a cyst resectable versus non-resectable.

If I were you, I would meet with my GI and go over the MRI findings and recommendations. In addition, and this is so you can have peace of mind, I would ask for a second opinion from a highly specialized center such as Mayo or in my case Froedtert & MCW. I got three medical opinions. This gave me the peace of mind and complete understanding on what needed to happen next.

Sending you Peace and Clarity. I know how scary this can be, take it one step at a time.

@carfbuch I message my GP and asked if it is benign or precancerous. I also asked if there is side branch dilation. She replied the following day with benign and no side branch dilation.

However, after carefully reading the report, it is classified as PAN2B (2-15)...

@castell Is this with S. CA Kaiser in Los Angeles? Sorry to hear about your pancreatic cancer. Did you feel that kaiser downplay the MRI results?

@lpaelevated4
I've reviewed my nine-year-old records. I had an ERCP, not an MRCP. The ERCP is more invasive, and can take X-rays, and allowed the gastroenterologist to insert a stent in my blocked bile duct.

I am in Kaiser in San Diego. I didn't feel they downplayed any test results. I think all doctors, including those at Kaiser, are very conscious of their potential legal liabilities if they overlook threats to your health. I asked for a second opinion at UCSD, but they would not pay for it.