Retrospective Study
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World J Gastrointest Endosc. Aug 16, 2014; 6(8): 366-372
Published online Aug 16, 2014. doi: 10.4253/wjge.v6.i8.366
Evaluation of diagnostic cytology via endoscopic naso-pancreatic drainage for pancreatic tumor
Tomoyuki Iwata, Katsuya Kitamura, Akira Yamamiya, Yu Ishii, Yoshiki Sato, Tomohiro Nomoto, Akitoshi Ikegami, Hitoshi Yoshida
Tomoyuki Iwata, Katsuya Kitamura, Akira Yamamiya, Yu Ishii, Yoshiki Sato, Tomohiro Nomoto, Akitoshi Ikegami, Hitoshi Yoshida, Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Shinagawa-ku, Tokyo 142-8666, Japan
Author contributions: Iwata T designed the study and wrote the manuscript; Kitamura K managed the medical record; Iwata T, Kitamura K, Sato Y, Nomoto T, Ikegami A and Yoshida H performed this procedure as endoscopic operators; Yamamiya A and Ishii Y helped with this procedure as 2nd operators; Yoshida H was also involved in editing the manuscript.
Correspondence to: Tomoyuki Iwata, MD, PhD, Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan. gat99apricot@yahoo.co.jp
Telephone: +81-3-37848535 Fax: +81-3-37847553
Received: March 14, 2014
Revised: May 18, 2014
Accepted: June 14, 2014
Published online: August 16, 2014
Processing time: 153 Days and 4.1 Hours
Abstract

AIM: To evaluate the usefulness of cytology of the pancreatic juice obtained via the endoscopic naso-pancreatic drainage tube (ENPD-C).

METHODS: ENPD was performed in cases where a diagnosis could not be made other than by using endoscopic retrograde cholangiopancreatography and in cases of pancreatic neoplasms or cystic tumors, including intraductal papillary mucinous neoplasm (IPMN) suspected to have malignant potential. 35 patients (21 males and 14 females) underwent ENPD between January 2007 and June 2013. The pancreatic duct was imaged and the procedure continued in one of ENPD-C or ENPD-C plus brush cytology (ENPD-BC). We checked the cytology result and the final diagnosis.

RESULTS: The mean patient age was 69 years (range, 48-86 years). ENPD-C was performed in 24 cases and ENPD-C plus brush cytology (ENPD-BC) in 11 cases. The ENPD tube was inserted for an average of 3.5 d. The final diagnosis was confirmed on the basis of the resected specimen in 18 cases and of follow-up findings at least 6 mo after ENPD in the 18 inoperable cases. Malignancy was diagnosed in 21 cases and 14 patients were diagnosed as having a benign condition. The ratios of class V/IV:III:II/I findings were 7:7:7 in malignant cases and 0:3:11 in benign cases. The sensitivity and specificity for all patients were 33.3% and 100%, respectively. The cytology-positive rate was 37.5% (6/16) for pancreatic cancer. For IPMN cases, the sensitivity and specificity were 33% and 100%, respectively.

CONCLUSION: Sensitivity may be further increased by adding brush cytology. Although we can diagnosis cancer in cases of a positive result, the accuracy of ENPD-C remains unsatisfactory.

Keywords: Endoscopic naso-pancreatic drainage; Pancreatic juice; Cytology; Pancreatic cancer; Intraductal papillary mucinous neoplasm

Core tip: This study was performed to evaluate the usefulness of cytology of the pancreatic juice obtained via the endoscopic naso-pancreatic drainage tube (ENPD-C). We retrospectively investigated 35 patients with pancreatic disease. ENPD-C was performed in 24 cases and ENPD-C plus brush cytology (ENPD-BC) in 11 cases. The sensitivity and specificity for all patients were 35% and 100%, respectively. The cytology-positive rate was 37.5% (6/16) for pancreatic cancer and 33% (1/3) for intraductal papillary mucinous cancer. Sensitivity may be further increased by adding brush cytology. We can diagnosis cancer in cases of a positive result (class V/IV) but the accuracy of ENPD-C remains unsatisfactory.