Pancreatic juice cytology for diagnosing invasive pancreatic carcinoma/high-grade pancreatic intraepithelial neoplasia without visible tumors on endoscopic ultrasound.

Autor: Sagami R; Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, Oita, Japan; Department of Gastroenterology, Oita San-ai Medical Centre, Oita, Oita, Japan., Mizukami K; Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, Oita, Japan. Electronic address: mizkaz0809@oita-u.ac.jp., Nishikiori H; Department of Gastroenterology, Oita San-ai Medical Centre, Oita, Oita, Japan., Sato T; Department of Gastroenterology, Oita San-ai Medical Centre, Oita, Oita, Japan., Fujiwara S; Department of Surgery, Oita San-ai Medical Centre, Oita, Oita, Japan., Kawamoto Y; Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan., Ome Y; Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan., Honda G; Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan., Horiguchi SI; Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Centre Komagome Hospital, Bunkyo-ku, Tokyo, Japan., Sato K; Department of Pathology, Oita San-ai Medical Centre, Oita, Oita, Japan., Murakami K; Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, Oita, Japan.
Jazyk: angličtina
Zdroj: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] [Pancreatology] 2024 Aug; Vol. 24 (5), pp. 740-746. Date of Electronic Publication: 2024 Jun 11.
DOI: 10.1016/j.pan.2024.06.006
Abstrakt: Objectives: Pancreatic ductal adenocarcinoma (PDAC) with a diameter ≤10 mm and high-grade pancreatic intraepithelial neoplasia (HG-PanIN) require pre-operative diagnosis. Most cases present only indirect imaging findings without visible tumors on endoscopic ultrasound (EUS). Therefore, EUS-guided fine-needle aspiration/biopsy is not applicable. An alternative diagnostic method is pancreatic juice cytology (PJC) via endoscopic naso-pancreatic drainage (ENPD-PJC), which is not the standard practice. This study aimed to investigate ENPD-PJC for diagnosing suspected PDAC/HG-PanIN cases without visible tumors on EUS.
Methods: Data of patients with suspected PDAC/HG-PanIN without visible tumors who underwent PJC were retrospectively evaluated. One PJC sample was collected during endoscopic retrograde pancreatography (ERP-PJC), and 12 samples were collected during ENPD-PJC, 3-hourly for cytological analysis. ERP-PJC, ERP/ENPD-PJC, and ENPD-PJC positivity indicated cytologically positive samples. Patients with positive/negative PJC with follow-up for <4-years were excluded as undiagnosed cases. A non-malignant diagnosis was based on histopathological absence/stable imaging findings for ≥4-years. The primary endpoint was to demonstrate that ERP/ENPD-PJC has a higher diagnostic ability than ERP-PJC.
Results: Twenty-two patients with histopathologically diagnosed PDAC/HG-PanIN and 31 with a non-malignant diagnosis were enrolled. ERP-PJC, ERP/ENPD-PJC, and ENPD-PJC showed sensitivities of 36.4 %, 86.4 %, and 77.3 %, specificities of 93.5 %, 87.1 %, and 93.5 %, and accuracies of 69.8 %, 86.7 %, and 86.7 %, respectively. ERP/ENPD-PJC and ENPD-PJC demonstrated superior sensitivity and accuracy compared to ERP-PJC. A greater occurrence of positive outcomes markedly distinguished true positives from false positives.
Conclusions: ERP/ENPD-PJC and ENPD-PJC had higher diagnostic accuracies for PDAC/HG-PanIN without visible tumors on EUS. ENPD-PJC is recommended for the diagnosis of these lesions.
Competing Interests: Declaration of competing interest The authors declare no conflicts of interest for this article.
(Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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