Diagnosing high-grade pancreatic intraepithelial neoplasia in surgically altered anatomy using pancreatic juice cytology

Q3 Medicine

VideoGIE Pub Date : 2025-02-21 DOI:10.1016/j.vgie.2025.02.006

Soma Fukuda MD , Susumu Hijioka MD, PhD , Kohei Okamoto MD , Shin Yagi MD , Mark Chatto MD , Yutaka Saito MD, PhD , Takuji Okusaka MD, PhD

{"title":"Diagnosing high-grade pancreatic intraepithelial neoplasia in surgically altered anatomy using pancreatic juice cytology","authors":"Soma Fukuda MD , Susumu Hijioka MD, PhD , Kohei Okamoto MD , Shin Yagi MD , Mark Chatto MD , Yutaka Saito MD, PhD , Takuji Okusaka MD, PhD","doi":"10.1016/j.vgie.2025.02.006","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and Aims</h3><div>Diagnosing early-stage pancreatic ductal adenocarcinoma, particularly high-grade pancreatic intraepithelial neoplasia (HG-PanIN), remains challenging. Serial pancreatic juice aspiration cytologic examination (SPACE) using an endoscopic nasopancreatic drainage tube has demonstrated high diagnostic accuracy, but its application in surgically altered anatomy is technically demanding. We present a case in which balloon enteroscopy-assisted SPACE led to the diagnosis of HG-PanIN and successful resection.</div></div><div><h3>Methods</h3><div>A 70-year-old man with a history of distal gastrectomy and Roux-en-Y reconstruction for gastric cancer underwent follow-up imaging, which revealed localized main pancreatic duct (MPD) stricture and parenchymal atrophy in the pancreatic tail. EUS identified a faint hypoechoic area around the stricture, but no distinct mass. EUS-guided tissue acquisition was inconclusive. Double-balloon enteroscopy-assisted endoscopic retrograde pancreatography was performed, revealing MPD stricture and distal dilation. A 5F endoscopic nasopancreatic drainage tube was placed across the stricture, and SPACE was conducted.</div></div><div><h3>Results</h3><div>Twelve pancreatic juice cytology samples were aspirated every 2 to 3 hours over 3 days, each exceeding 1 mL. One sample (10th) was classified as Class IV, “suspicious for adenocarcinoma,” with cytology revealing nuclear enlargement and atypia. The patient was diagnosed preoperatively with pancreatic cancer (TisN0M0 stage 0) and underwent distal pancreatectomy without neoadjuvant chemotherapy. Pathology confirmed HG-PanIN of the MPD. The patient had no postoperative adverse events and remained recurrence-free at the 9-month follow-up.</div></div><div><h3>Conclusions</h3><div>This case highlights the effectiveness of balloon enteroscopy-assisted SPACE in diagnosing HG-PanIN in surgically altered anatomy. However, given the relatively high risk of pancreatitis, SPACE should be reserved for patients with imaging or clinical findings suggestive of malignancy. By overcoming technical obstacles, this method offers a promising diagnostic strategy for early-stage pancreatic ductal adenocarcinoma in surgically altered anatomy.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 6","pages":"Pages 302-306"},"PeriodicalIF":0.0000,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"VideoGIE","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2468448125000360","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Background and Aims

Diagnosing early-stage pancreatic ductal adenocarcinoma, particularly high-grade pancreatic intraepithelial neoplasia (HG-PanIN), remains challenging. Serial pancreatic juice aspiration cytologic examination (SPACE) using an endoscopic nasopancreatic drainage tube has demonstrated high diagnostic accuracy, but its application in surgically altered anatomy is technically demanding. We present a case in which balloon enteroscopy-assisted SPACE led to the diagnosis of HG-PanIN and successful resection.

Methods

A 70-year-old man with a history of distal gastrectomy and Roux-en-Y reconstruction for gastric cancer underwent follow-up imaging, which revealed localized main pancreatic duct (MPD) stricture and parenchymal atrophy in the pancreatic tail. EUS identified a faint hypoechoic area around the stricture, but no distinct mass. EUS-guided tissue acquisition was inconclusive. Double-balloon enteroscopy-assisted endoscopic retrograde pancreatography was performed, revealing MPD stricture and distal dilation. A 5F endoscopic nasopancreatic drainage tube was placed across the stricture, and SPACE was conducted.

Results

Twelve pancreatic juice cytology samples were aspirated every 2 to 3 hours over 3 days, each exceeding 1 mL. One sample (10th) was classified as Class IV, “suspicious for adenocarcinoma,” with cytology revealing nuclear enlargement and atypia. The patient was diagnosed preoperatively with pancreatic cancer (TisN0M0 stage 0) and underwent distal pancreatectomy without neoadjuvant chemotherapy. Pathology confirmed HG-PanIN of the MPD. The patient had no postoperative adverse events and remained recurrence-free at the 9-month follow-up.

Conclusions

This case highlights the effectiveness of balloon enteroscopy-assisted SPACE in diagnosing HG-PanIN in surgically altered anatomy. However, given the relatively high risk of pancreatitis, SPACE should be reserved for patients with imaging or clinical findings suggestive of malignancy. By overcoming technical obstacles, this method offers a promising diagnostic strategy for early-stage pancreatic ductal adenocarcinoma in surgically altered anatomy.

查看原文本刊更多论文

胰液细胞学在手术改变解剖中诊断高级别胰腺上皮内瘤变

背景和目的诊断早期胰腺导管腺癌，特别是高级别胰腺上皮内瘤变（HG-PanIN），仍然具有挑战性。应用内镜下鼻胰引流管进行连续胰液抽吸细胞学检查（SPACE）已显示出较高的诊断准确性，但其在手术改变解剖结构中的应用在技术上要求很高。我们提出一个病例，其中气囊小肠镜辅助SPACE导致HG-PanIN的诊断和成功切除。方法70岁男性，因胃癌行远端胃切除术及Roux-en-Y重建术，行随访影像学检查，发现胰腺尾部局部主胰管狭窄及实质萎缩。EUS发现狭窄周围有微弱的低回声区，但没有明显的肿块。eus引导下的组织采集尚无定论。双球囊肠镜辅助下行内镜逆行胰脏造影，显示MPD狭窄及远端扩张。5F内镜下鼻胰引流管横过狭窄，行间隙引流。结果3天内，每2 ~ 3小时抽取12例胰液细胞学样本，每例样本均超过1 mL，其中1例（第10例）为ⅳ类，“怀疑腺癌”，细胞学显示核肿大和非典型性。患者术前诊断为胰腺癌（TisN0M0期），行远端胰腺切除术，未行新辅助化疗。病理证实MPD为HG-PanIN。患者术后无不良事件发生，随访9个月无复发。结论本病例强调了气囊小肠镜辅助SPACE在手术改变解剖中诊断HG-PanIN的有效性。然而，考虑到胰腺炎的风险相对较高，SPACE应保留给有影像学或临床表现提示恶性肿瘤的患者。通过克服技术障碍，该方法为手术改变解剖结构的早期胰腺导管腺癌提供了一种有希望的诊断策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.