Main pancreatic duct stenosis without detecting tumor

Abstract

Focal pancreatic stenosis and focal pancreatic atrophy are features of early-stage pancreatic cancer including carcinoma in situ. We have performed endoscopic retrograde pancreatography (ERPs) on patients with focal pancreatic stenosis with no apparent tumor seen despite multiple imaging studies. Clinical data were collected from 36 patients over 37 sessions who underwent pathological examination by ERPs from January 2010 to December 2020. This included 18 males and 19 females, median age 74 years, and median observation period of 952 days. Of the 37 sessions, 12 were malignant, and 25 benign lesions. The sensitivity of ERP cytology was: pancreatic juice cytology 50%, brush cytology 57%, SPACE 50%, and whole ERP cytology 67%. The malignant group had less acute pancreatitis history, and more males, more stenosis length less than 5 mm, and more focal pancreatic atrophy compared to the benign group. Within the 4 malignant sessions that could not be diagnosed by ERP cytology, 2 were diagnosed with metastases within one year of the final ERP session. About 30% of focal pancreatic stenosis without tumor being detected was malignant, especially in patients with shorter length stenosis and with focal pancreatic atrophy. ERP cytology is a valuable method for detecting pancreatic cancer.