Clinical usefulness of repeated pancreatic juice cytology via endoscopic naso-pancreatic drainage tube in patients with pancreatic cancer

Mikata, Rintaro; Ishihara, Takeshi; Tada, Motohisa; Tawada, Katsunobu; Saito, Masayoshi; Kurosawa, Joe; Sugiyama, Harutoshi; Sakai, Yuji; Tsuyuguchi, Toshio; Miyazaki, Masaru; Yokosuka, Osamu

doi:10.1007/s00535-012-0684-y

Cited by 66 publications

(78 citation statements)

References 25 publications

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“…Recently, there have been some reports of cytodiagnosis multiple times using PJ obtained by ENPD. The sensitivity and accuracy for diagnosis of PCIS using this method was 100%, and 95%, respectively 64, 70, 71. Current Japanese CGL for PC recommends cytodiagnosis multiple times using PJ during ERCP when localized stenosis of MPD is observed by MRCP, EUS, or ERCP 14…”

Section: Diagnosis Of Pcismentioning

confidence: 88%

Early diagnosis of pancreatic cancer: Current trends and concerns

Hanada

Amano

Abe

2017

Annals of Gastroent Surgery

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Early detection of pancreatic cancer (PC) is essential for a better prognosis. Some recent studies have demonstrated that a slight dilatation of the main pancreatic duct (MPD) and small cystic lesions were detected initially in most cases diagnosed at an early stage. Detecting these abnormal findings in cases with high risk factors through an effective screening system including image diagnosis, some biological markers, or familial cancer registrations should contribute to early diagnosis of PC. It has been reported that endoscopic ultrasonography (EUS) is essential for detecting tumors <10 mm with a favorable prognosis. Additionally, EUS‐guided fine‐needle aspiration biopsy is useful for confirming final histological diagnosis. For the diagnosis of stage 0 PC, local irregular stenosis of MPD should be an important initial abnormal sign detected by EUS or magnetic resonance cholangiopancreatography. Cytodiagnosis multiple times using pancreatic juice obtained by endoscopic nasopancreatic drainage should be essential for the final diagnosis. Recently, activities of regional networks between specialist doctors in medical centers and general practitioners for early diagnosis of PC have been reported in Japan. In the future, these activities may play an important role in the early diagnosis of PC.

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Section: Diagnosis Of Pcismentioning

confidence: 88%

Early diagnosis of pancreatic cancer: Current trends and concerns

Hanada

Amano

Abe

2017

Annals of Gastroent Surgery

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“…This chapter describes how chronic pancreatitis is suspected, based on signs, symptoms, and laboratory results, and how the diagnosis is developed. The CQ are very detailed and consist of 12 items, including history taking, physical examination, determination methods for pancreatic enzymes in the blood and urine [5,6], significance of various imaging methods [chest and abdominal radiography, abdominal ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasound, and pancreatography] in the diagnosis of chronic pancreatitis [7][8][9][10][11][12][13][14][15], exocrine pancreatic function testing, pathological diagnosis, differential diagnosis from pancreatic cancer and intraductal papillary mucinous neoplasm (IPMN), and genetic testing [16][17][18][19][20].…”

Section: Diagnosismentioning

confidence: 99%

Evidence-based clinical practice guidelines for chronic pancreatitis 2015

et al. 2016

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Chronic pancreatitis is considered to be an irreversible progressive chronic inflammatory disease. The etiology and pathology of chronic pancreatitis are complex; therefore, it is important to correctly understand the stage and pathology and provide appropriate treatment accordingly. The newly revised Clinical Practice Guidelines of Chronic Pancreatitis 2015 consist of four chapters, i.e., diagnosis, staging, treatment, and prognosis, and includes a total of 65 clinical questions. These guidelines have aimed at providing certain directions and clinically practical contents for the management of chronic pancreatitis, preferentially adopting clinically useful articles. These revised guidelines also refer to early chronic pancreatitis based on the Criteria for the Diagnosis of Chronic Pancreatitis 2009. They include such items as health insurance coverage of high-titer lipase preparations and extracorporeal shock wave lithotripsy, new antidiabetic drugs, and the definition of and treatment approach to pancreatic pseudocyst. The accuracy of these guidelines has been improved by examining and adopting new evidence obtained after the publication of the first edition.

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“…There are previous reports using cytology with pancreatic juice, including repeated cytology of pancreatic juice obtained using an ENPD tube and brush cytology, for diagnosis of highgrade PanINs and small pancreatic cancer. Using repeated cytology with an ENPD tube, Iiboshi et al [6] reported a sensitivity, specificity, and accuracy of detecting highgrade PanIN and small pancreatic cancer of 100, 83.3, and 95%, respectively, while Mikata et al [7] reported a sensitivity, specificity, and accuracy of detecting pancreatic cancer, including advanced pancreatic cancer, of 80, 100, and 87%, respectively, which was significantly higher than the sensitivity, specificity, and accuracy obtained when using single cytology. Further, 1 study reported diagnosis using brush cytology in a high-grade PanIN patient [5] .…”

Section: Discussionmentioning

confidence: 99%

Detection of High-Grade Pancreatic Intraepithelial Neoplasia without Morphological Changes of the Main Pancreatic Duct over a Long Period: Importance for Close Follow-Up for Confirmation

Yamao

Takenaka²,

Nakai³

et al. 2017

Oncology

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Pancreatic intraepithelial neoplasia (PanIN) is a microscopic papillary noninvasive lesion arising from the pancreatic ductal epithelium. However, the natural history and time to progression of high-grade PanIN remain unclear. Herein, we report 2 cases of high-grade PanIN without morphological changes of the main pancreatic duct (MPD) over relatively long periods. In the first case, a 63-year-old man was identified with MPD dilation. Magnetic resonance cholangiopancreatography showed localized stenosis in the pancreatic body with distal MPD dilation. Endoscopic retrograde pancreatography (ERP) was attempted because of possible high-grade PanIN but was unsuccessful. At 15-month follow-up, there was no change in the form of the MPD in various images. However, ERP was re-performed because of possible high-grade PanIN, and cytology showed adenocarcinoma. Postoperative pathology indicated diffuse lesions corresponding to high-grade PanINs in the MPD stenosis and surrounding branches. Final diagnosis was high-grade PanIN. In the second case, a 77-year-old man was identified with MPD dilation. Magnetic resonance cholangiography showed localized stenosis in the MPD of the pancreatic head with distal MPD dilation. He was diagnosed with MPD stenosis caused by chronic pancreatitis, and further examination was not recommended. At 25 months, the patient was referred to our hospital because of a mild change in MPD dilation. ERP showed localized irregular stenosis in the MPD, and cytology showed suspected adenocarcinoma. Postoperative pathology indicated a localized lesion with high-grade PanIN in the branch duct around the MPD stenosis. Final diagnosis was high-grade PanIN. In conclusion, we report 2 cases of high-grade PanIN without morphological changes of the MPD over relatively long periods. Even if a definite diagnosis is not obtained at initial examination, a strict follow-up observational study should be performed. Re-examination, including ERP, should also be considered in cases with risk factors of pancreatic cancer, even if there is no change in MPD form.

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Clinical usefulness of repeated pancreatic juice cytology via endoscopic naso-pancreatic drainage tube in patients with pancreatic cancer

Abstract: The ENPD method was found to have high diagnostic yield, especially for tumors less than 20 mm or located in the pancreatic head, and might be useful for the diagnosis of early-stage pancreatic cancer.

Cited by 66 publications

References 25 publications

Early diagnosis of pancreatic cancer: Current trends and concerns

Early diagnosis of pancreatic cancer: Current trends and concerns

Evidence-based clinical practice guidelines for chronic pancreatitis 2015

Detection of High-Grade Pancreatic Intraepithelial Neoplasia without Morphological Changes of the Main Pancreatic Duct over a Long Period: Importance for Close Follow-Up for Confirmation

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