Diagnostic yield of endoscopic retrograde cholangiopancreatography‐based cytology for distinguishing malignant and benign intraductal papillary mucinous neoplasm: <scp>S</scp>ystematic review and meta‐analysis

Suzuki, Rei; Thosani, Nirav; Annangi, Srinadh; Komarraju, Aparna; Irisawa, Atsushi; Ohira, Hiromasa; Obara, Katsutoshi; Fleming, Jason B.; Guha, Sushovan; Bhutani, Manoop S.

doi:10.1111/den.12230

Cited by 28 publications

(17 citation statements)

References 33 publications

(81 reference statements)

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“…Pancreatic juice cytology during ERCP is useful for the pathological diagnosis of pancreatic neoplasms, especially those that are derived from the pancreatic duct, such as IDC (9). On the other hand, it might be difficult to diagnose a pancreatic neoplasm that is not derived from the pancreatic duct, such as a PPL, using pancreatic juice cytology.…”

Section: Discussionmentioning

confidence: 99%

Primary Pancreatic Malignant Lymphoma Diagnosed from Endoscopic Ultrasound-guided Fine-needle Aspiration Findings

et al. 2016

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A 60-year-old woman was admitted to our hospital with upper abdominal pain and jaundice. Computed tomography showed a 9-cm mass that was penetrated by the common hepatic artery in the pancreatic head area. Endoscopic retrograde pancreatography revealed no stenosis or obstruction of the main pancreatic duct, and a cytologic examination of the patient's pancreatic juice was negative. Next, endoscopic ultrasoundguided fine needle aspiration was performed. The immunohistological findings of the specimen revealed a diffuse large B-cell lymphoma. The size of the tumor was significantly reduced after 8 cycles of R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone).

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Section: Discussionmentioning

confidence: 99%

Primary Pancreatic Malignant Lymphoma Diagnosed from Endoscopic Ultrasound-guided Fine-needle Aspiration Findings

et al. 2016

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“…Pancreatic juice cytology (PJC) under endoscopic retrograde cholangiopancreatography (ERCP) is an examination for IPMNs, and suspicion of malignancy or positive malignancy by PJC is an absolute indication for resection. However, the sensitivity of PJC for malignant IPMN was found to be only 35% in a meta-analysis, 13 and the accuracy was also unsatisfactory (33%-64%). 2,[14][15] Furthermore, the incidence of post-ERCP pancreatitis (PEP) was also reported to be about 8%-25%.…”

Section: Ipmnmentioning

confidence: 99%

The efficacy of pancreatic juice cytology with liquid-based cytology for evaluating malignancy in patients with intraductal papillary mucinous neoplasm

Miyamoto

Matsumoto²,

Kato

et al. 2020

Preprint

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Background: Pancreatic juice cytology (PJC) is a tool for diagnosing malignant intraductal papillary mucinous neoplasm (IPMN); however, the accuracy is insufficient using the conventional method. Liquid-based cytology (LBC) improves the cell recovery rate, and almost all cells can be evaluated. We evaluated the efficacy of PJC with LBC for malignant IPMN. Methods: We retrospectively analyzed 90 patients with suspected malignant IPMN who underwent PJC before pancreatectomy. PJC with smear and LBC methods was conducted in 52 patients (between June 2003 to December 2011) and 38 patients (between January 2012 to December 2018). Based on the imaging studies, all of the patients were classified according to the international consensus guidelines for IPMN revised in 2017.Results: Of the 90 patients, 43 (48%) had malignant IPMN (high-grade dysplasia or invasive carcinoma), and the remaining patients had non-malignant IPMN (intermediate- or low-grade dysplasia). LBC increased the accuracy of PJC for the diagnosis of malignant IPMN (smear method: 56% [29/52] vs. LBC method: 76% [29/38]; P = 0.044). In a multivariate analysis, LBC was a significant factor influencing the accurate diagnosis of PJC (odds ratio: 3.52; P = 0.021). Furthermore, LBC increased the accuracy of PJC for malignant IPMN in patients with worrisome features (smear method: 66% [19/29] vs. LBC method: 93% [14/15]; P = 0.043). Conclusions: LBC increases the accuracy of PJC for diagnosing malignant IPMN compared with the conventional smear method.

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“…Assessment of pancreatic juice by a transpapillary approach is useful in the differential diagnosis of benign and malignant IPMN (Table 4). 10,[68][69][70] A meta-analysis of 13 studies that included 483 patients with IPMN found that ERCP cytology had a pooled sensitivity, specificity, and accuracy of 35.1%, 97.2%, and 92.9%, respectively, in the differential diagnosis of benign and malignant IPMN. 68 In this meta-analysis, lavage cytology improved the sensitivity to 45.8%.…”

Section: Assessment Of Pancreatic Juice By a Transpapillary Approachmentioning

confidence: 99%

Endoscopic diagnosis of cystic lesions of the pancreas

Kamata

Kitano

2018

Digestive Endoscopy

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Endoscopic methods are increasingly used in the diagnosis of cystic lesions of the pancreas. The two major endoscopic approaches are endoscopic ultrasonography (EUS) and transpapillary diagnosis. EUS-guided fine-needle aspiration cytology and EUS-guided fine needle-based confocal laser endomicroscopy have been used in the differential diagnosis of mucinous and non-mucinous pancreatic cysts. EUS is the most sensitive modality for detecting mural nodules (MN) in intraductal papillary mucinous neoplasms (IPMN). Contrast-enhanced harmonic EUS (CH-EUS), as an add-on to EUS, is useful for identifying and characterizing MN. Recent studies show that CH-EUS has a sensitivity of 60-100% and a specificity of 75-92.9% for diagnosing malignant cysts. Intraductal ultrasonography and peroral pancreatoscopy are especially useful for detecting MN and IPMN. A recent meta-analysis showed that cytological assessment of pancreatic juice using a transpapillary approach had a pooled sensitivity, specificity, and accuracy of 35.1%, 97.2%, and 92.9%, respectively, for diagnosing malignant IPMN. Further studies are warranted to determine the indications for each of these novel techniques in assessing cystic lesions of the pancreas.

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Diagnostic yield of endoscopic retrograde cholangiopancreatography‐based cytology for distinguishing malignant and benign intraductal papillary mucinous neoplasm: Systematic review and meta‐analysis

Abstract: Cytology from ERCP has good specificity but poor sensitivity in distinguishing benign from malignant IPMN. Newer techniques or markers are needed to improve diagnostic yield.

Cited by 28 publications

References 33 publications

Primary Pancreatic Malignant Lymphoma Diagnosed from Endoscopic Ultrasound-guided Fine-needle Aspiration Findings

Primary Pancreatic Malignant Lymphoma Diagnosed from Endoscopic Ultrasound-guided Fine-needle Aspiration Findings

The efficacy of pancreatic juice cytology with liquid-based cytology for evaluating malignancy in patients with intraductal papillary mucinous neoplasm

Endoscopic diagnosis of cystic lesions of the pancreas

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