Diagnostic Ability and Safety of Repeated Pancreatic Juice Cytology Using an Endoscopic Nasopancreatic Drainage Catheter for Pancreatic Ductal Adenocarcinoma: A Multicenter Prospective Study

Abstract

Pathological examination is essential for the diagnosis and treatment of pancreatic ductal adenocarcinoma (PDAC). Moreover, a reliable pathological diagnosis is extremely important for improving prognosis, especially in early-stage PDAC. This study prospectively evaluated the usefulness of repeated pancreatic juice cytology (PJC) using an endoscopic nasopancreatic drainage (ENPD) catheter for the diagnosis of PDAC. We enrolled 82 patients suspected of having resectable PDAC, based on imaging studies, and judged the necessity for cytology. The diagnostic yield of up to six repeated PJCs and the incidence of complications, such as pancreatitis, was evaluated. A total of 60 patients were diagnosed with PDAC. The overall sensitivity and specificity were 46.7% and 95.5%, respectively. The cumulative positivity rate increased with the number of sampling sessions, reaching 58.3% in the sixth session. The sensitivity was significantly higher in the pancreatic head than in the pancreatic tail (p = 0.043). Additionally, it was 100% in four patients with a tumor size ≤10 mm. Pancreatitis occurred in six patients (7.3%), all of whom were treated conservatively. In the diagnosis of PDAC, repeated PJC using an ENPD catheter revealed a cumulative effect of sensitivity up to six times and an excellent diagnostic yield for small PDAC.

Early diagnosis of pancreatic cancer via pancreatic juice cytology with a cell-block method in a patient with altered anatomy

“…Pancreatic juice cytology (PJC) performed via endoscopic retrograde cholangiopancreatography (ERCP) has been adapted as an alternative to endoscopic ultrasonography-guided tissue acquisition for identifying pancreatic ductal adenocarcinoma (PDAC) in cases in which mass lesions cannot be visualized; however, its diagnostic accuracy is limited 1 2 . Recently, PJC using a cell-block (CB) technique (in which tissue fragments obtained from pancreatic juice are processed into paraffin blocks) has been reported 3 4 5 .…”

Early detection of pancreatic cancer

“…Moreover, it was shown in the study by Iiboshi et al [ 12 ] were 7 of 15 patients presenting with focal stenosis and distal dilatation of the main pancreatic duct and included in the ENPD placement group were diagnosed with carcinoma in situ . The cytology of pancreatic juice is a procedure which has attracted the attention in the eastern groups, particularly in Japan centers[ 13 - 15 ], however its practice is not extended in the western countries. Only one study from a western institution has been published focusing in the DNA methylation analysis in isolated but non-multiple samples of pancreatic juice obtained in intraoperative pancreatic resections or by ERCP intubation in non-operated on patients[ 16 ], still it only has reached a research interest and has not been expanded in clinical practice.…”