Pancreatic juice cytology in the diagnosis of intraductal papillary mucinous neoplasm of the pancreas

Abstract

BACKGROUND The examination of pancreatic juice cytology could hypothetically contribute to the establishment of a definite diagnosis of malignant intraductal papillary mucinous neoplasm of the pancreas (IPMN), but to the authors' knowledge, its significance has not been confirmed to date. The current study was conducted to assess the diagnostic value of pancreatic juice cytology in IPMN and to examine the usefulness of peroral pancreatoscopy (POPS) in sampling pancreatic juice. METHODS The study subjects were comprised of 103 patients with IPMN who underwent surgical resection of pancreatic tumors (adenoma in29 patients, borderline in17 patients, carcinoma in situ in 25 patients, and invasive carcinoma in 32 patients). Pancreatic juice was collected with a catheter in 71 patients and by POPS in 32 patients. Patients with pancreatic carcinoma (n = 81) and chronic pancreatitis (n = 76) also were investigated. RESULTS The cytologic diagnosis was found to be of nondiagnostic value in only one patient with an IPMN, whereas it was of no diagnostic value in 14 of the patients with pancreatic carcinoma (17.3%), a difference that was statically significant (P < 0.001). The location of the IPMN (either in the pancreas or the pancreatic ducts) was not found to significantly affect the diagnostic value of the test. The sensitivity for IPMN was 62.2% when pancreatic juice was collected by POPS, and was 38.2% when it was collected using a catheter. In the case of pancreatic carcinoma, the sensitivity of pancreatic juice cytology was found to be 25.4%, which was significantly lower than that for IPMN when the pancreatic juice was collected by POPS (P < 0.001). CONCLUSIONS Pancreatic juice cytology was found to have better diagnostic value in the patients with IPMNs compared with those with pancreatic carcinoma. POPS was found to be useful for the collection of pancreatic juice. Cancer 2005. © 2005 American Cancer Society.

Size of mural nodule as an indicator of surgery for branch duct intraductal papillary mucinous neoplasm of the pancreas during follow-up

“…Branch duct IPMNs that could be followed up were selected, and also cytologic examination of pancreatic juice was performed for all the IPMNs during ERCP in order to exclude malignant neoplasms. Cytology is useful for discriminating benign from malignant branch duct IPMNs, although this modality is not as useful as it is for discriminating benign from malignant main duct IPMNs ( [22] and our unpublished data).…”

Peroral Cholangiopancreatoscopy with the SpyGlass® System: What do we Know 10 Years Later

“…A study by Yamaguchi et al [37] reported an improved ability to diagnose IPMNs by pancreatic cytology using "mother-baby" systems. Importantly, this study also found that there is no diagnostic value for pancreatic juice cytology in the diagnosis of pancreatic carcinoma.…”

Intraductal therapies

“…Most of the studies on pancreatoscopy have been conducted in patients with intraductal papillary mucinous neoplasms (IPMNs) [36][37][38][39]. Diagnostic yield of POPS with or without POPS-guided biopsy for malignancy in IPMN are reported, and range from 50 to 68% sensitivity and from 87 to 100% specificity.…”