Pancreatic juice cytology for diagnosing invasive pancreatic carcinoma/high-grade pancreatic intraepithelial neoplasia without visible tumors on endoscopic ultrasound

IF 2.8 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology Pub Date : 2024-06-11 DOI:10.1016/j.pan.2024.06.006

Ryota Sagami , Kazuhiro Mizukami , Hidefumi Nishikiori , Takao Sato , Shozo Fujiwara , Yusuke Kawamoto , Yusuke Ome , Goro Honda , Shin-ichiro Horiguchi , Keiji Sato , Kazunari Murakami

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引用次数: 0

Abstract

Objectives

Pancreatic ductal adenocarcinoma (PDAC) with a diameter ≤10 mm and high-grade pancreatic intraepithelial neoplasia (HG-PanIN) require pre-operative diagnosis. Most cases present only indirect imaging findings without visible tumors on endoscopic ultrasound (EUS). Therefore, EUS-guided fine-needle aspiration/biopsy is not applicable. An alternative diagnostic method is pancreatic juice cytology (PJC) via endoscopic naso-pancreatic drainage (ENPD-PJC), which is not the standard practice. This study aimed to investigate ENPD-PJC for diagnosing suspected PDAC/HG-PanIN cases without visible tumors on EUS.

Methods

Data of patients with suspected PDAC/HG-PanIN without visible tumors who underwent PJC were retrospectively evaluated. One PJC sample was collected during endoscopic retrograde pancreatography (ERP-PJC), and 12 samples were collected during ENPD-PJC, 3-hourly for cytological analysis. ERP-PJC, ERP/ENPD-PJC, and ENPD-PJC positivity indicated cytologically positive samples. Patients with positive/negative PJC with follow-up for <4-years were excluded as undiagnosed cases. A non-malignant diagnosis was based on histopathological absence/stable imaging findings for ≥4-years. The primary endpoint was to demonstrate that ERP/ENPD-PJC has a higher diagnostic ability than ERP-PJC.

Results

Twenty-two patients with histopathologically diagnosed PDAC/HG-PanIN and 31 with a non-malignant diagnosis were enrolled. ERP-PJC, ERP/ENPD-PJC, and ENPD-PJC showed sensitivities of 36.4 %, 86.4 %, and 77.3 %, specificities of 93.5 %, 87.1 %, and 93.5 %, and accuracies of 69.8 %, 86.7 %, and 86.7 %, respectively. ERP/ENPD-PJC and ENPD-PJC demonstrated superior sensitivity and accuracy compared to ERP-PJC. A greater occurrence of positive outcomes markedly distinguished true positives from false positives.

Conclusions

ERP/ENPD-PJC and ENPD-PJC had higher diagnostic accuracies for PDAC/HG-PanIN without visible tumors on EUS. ENPD-PJC is recommended for the diagnosis of these lesions.

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胰液细胞学诊断浸润性胰腺癌/高级别胰腺上皮内瘤变，内镜超声检查无可见肿瘤

目的直径≤10 毫米的胰腺导管腺癌（PDAC）和高级别胰腺上皮内瘤变（HG-PanIN）需要进行术前诊断。大多数病例在内镜超声（EUS）检查中仅有间接影像学检查结果，看不到肿瘤。因此，EUS 引导下的细针穿刺/活组织检查并不适用。另一种诊断方法是通过内镜鼻胰引流术（ENPD-PJC）进行胰液细胞学检查（PJC），但这并非标准做法。本研究旨在探讨ENPD-PJC在诊断EUS未见可见肿瘤的疑似PDAC/HG-PanIN病例中的应用。在内镜逆行胰腺造影（ERP-PJC）过程中采集了一份PJC样本，在ENPD-PJC过程中采集了12份样本，每3小时进行一次细胞学分析。ERP-PJC、ERP/ENPD-PJC 和 ENPD-PJC 阳性表示样本细胞学阳性。PJC阳性/阴性且随访4年的患者被排除在未确诊病例之外。非恶性诊断基于组织病理学缺失/影像学结果稳定≥4年。主要终点是证明ERP/ENPD-PJC比ERP-PJC具有更高的诊断能力。结果22例经组织病理学诊断为PDAC/HG-PanIN的患者和31例非恶性诊断的患者入选。ERP-PJC、ERP/ENPD-PJC 和 ENPD-PJC 的敏感性分别为 36.4%、86.4% 和 77.3%，特异性分别为 93.5%、87.1% 和 93.5%，准确性分别为 69.8%、86.7% 和 86.7%。与ERP-PJC相比，ERP/ENPD-PJC和ENPD-PJC显示出更高的灵敏度和准确性。结论 ERP/ENPD-PJC 和 ENPD-PJC 对 EUS 上无可见肿瘤的 PDAC/HG-PanIN 具有更高的诊断准确性。推荐使用 ENPD-PJC 诊断这些病变。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pancreatology 医学-胃肠肝病学

CiteScore

7.20

自引率

5.60%

发文量

194

审稿时长

44 days

期刊介绍： Pancreatology is the official journal of the International Association of Pancreatology (IAP), the European Pancreatic Club (EPC) and several national societies and study groups around the world. Dedicated to the understanding and treatment of exocrine as well as endocrine pancreatic disease, this multidisciplinary periodical publishes original basic, translational and clinical pancreatic research from a range of fields including gastroenterology, oncology, surgery, pharmacology, cellular and molecular biology as well as endocrinology, immunology and epidemiology. Readers can expect to gain new insights into pancreatic physiology and into the pathogenesis, diagnosis, therapeutic approaches and prognosis of pancreatic diseases. The journal features original articles, case reports, consensus guidelines and topical, cutting edge reviews, thus representing a source of valuable, novel information for clinical and basic researchers alike.