Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) in Differentiating Benign and Malignant Causes of Obstructive Jaundice Using Histopathology as the Reference Standard

MRCP in Benign and Malignant Causes of Obstructive Jaundice Using Histopathology

Abstract

Obstructive jaundice requires accurate differentiation between benign and malignant causes to guide management and prognosis. Magnetic resonance cholangiopancreatography (MRCP) is increasingly used as a non-invasive diagnostic modality; however, local evidence comparing MRCP findings with histopathology remains limited. Objectives: To evaluate the diagnostic accuracy of MRCP in differentiating benign from malignant obstructive jaundice using histopathology as the reference standard. Methods: This retrospective cross-sectional study included 103 patients with obstructive jaundice who underwent MRCP followed by histopathological confirmation between June and December 2025. Biochemical parameters and imaging findings were analyzed. Sensitivity, specificity, predictive values, overall accuracy, and area under the receiver operating characteristic curve (AUC) were calculated. Results: Histopathology confirmed 54 (52.4%) benign and 49 (47.6%) malignant cases. Total bilirubin, direct bilirubin, ALT, AST, ALP, and CA 19-9 levels were significantly higher in malignant cases (all p<0.001), while duration of jaundice, GGT, and stricture length showed no significant difference (p>0.005). MRCP demonstrated a sensitivity of 95.9%, specificity of 96.3%, positive predictive value of 95.9%, negative predictive value of 96.3%, and overall accuracy of 96.1%. ROC analysis showed excellent diagnostic performance (AUC = 0.961; 95% CI: 0.918–1.000; p<0.001). Conclusions: MRCP demonstrates excellent diagnostic accuracy in differentiating malignant from benign obstructive jaundice and serves as a reliable non-invasive imaging modality for clinical decision-making.