| Institution: | 1. Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan;2. Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan;3. Department of Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan;1. Department of Pathology, Incheon St. Mary''s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea;2. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;3. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;4. Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;1. Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China;2. Emergency Department, Third Xiangya Hospital, Central South University, Changsha, China;1. Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA;2. Department of Surgery, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, United Kingdom;3. Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA;1. Pediatric Nutritional Medicine & Else Kröner-Fresenius-Centre for Nutritional Medicine (EKFZ), Technical University Munich (TUM), Freising, Germany;2. Department of Pediatrics, MRI, Technical University Munich (TUM), Munich, Germany;3. Institute of Transfusion Medicine and Immunology, Heidelberg University, Medical Faculty Mannheim, German Red Cross Blood Service Baden, Württemberg, Hessen, Mannheim, Germany;4. Department of Internal Medicine I, Martin Luther University, Halle, Germany |
| Abstract: | BackgroundEndoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is extremely useful for pathological diagnosis of pancreatic ductal adenocarcinoma (PDAC); however, puncturing is difficult in some cases, and there is a risk of needle tract seeding. This study evaluated the indications for endoscopic retrograde pancreatography-based (ERP)-based cytology for the preoperative diagnosis of PDAC.MethodsThis study included 267 patients with PDAC who underwent preoperative ERP. The diagnostic performance of ERP-based cytology for PDAC was evaluated based on the sample collection method (pancreatic juice cytology PJC] during ERP, brush cytology, PJC via endoscopic nasopancreatic drainage ENPD] catheter), lesion site (pancreatic head, body/tail), and lesion size (≤10 mm, 10–20 mm, >20 mm), and compared with the diagnostic performance of EUS-FNA.ResultsThe overall sensitivity of ERP-based cytology was 54.9%; sensitivity by the sampling method was 34.7% for PJC during ERP, 65.8% for brush cytology, and 30.8% for PJC via an ENPD catheter. The sensitivity of EUS-FNA was 85.3%. Brush cytology and PJC via an ENPD catheter were performed more often in pancreatic body/tail lesions than in head lesions (P = 0.016 and P < 0.001, respectively), and the overall sensitivity of ERP-based cytology was better for body/tail lesions (63.2% vs. 49.0%, P = 0.025). The sensitivities of ERP-based cytology and EUS-FNA in diagnosing PDAC ≤10 mm were 92.3% and 33.3%, respectively. Post-ERP pancreatitis was observed in 22 patients (8.2%) and significantly less common with ENPD catheters (P = 0.002).ConclusionsERP-based cytology may be considered the first choice for pathological diagnosis of PDAC ≤10 mm and in the pancreatic body/tail. |
