This study aimed to clarify the efficacy and safety of pancreatic duct lavage cytology combined with a cell-block method (PLC-CB) for possible pancreatic ductal adenocarcinomas (PDACs).
This study included 41 patients with suspected PDACs who underwent PLC-CB mainly because they were unfit for undergoing endoscopic ultrasonography-guided fine needle aspiration. A 6-Fr double lumen catheter was mainly used to perform PLC-CB. Final diagnoses were obtained from the findings of resected specimens or clinical outcomes during surveillance after PLC-CB.
Histocytological evaluations using PLC-CB were performed in 87.8% (36/41) of the patients. For 31 of the 36 patients, final diagnoses (invasive PDAC, 12; pancreatic carcinoma
PLC-CB has an excellent ability to detect malignancies in patients with possible PDACs, including pancreatic carcinoma
The high diagnostic accuracy of endoscopic ultrasonography (EUS)-guided fine needle aspiration (FNA) cytology makes it the most accepted procedure for the preoperative histocytological diagnosis of pancreatic ductal adenocarcinomas (PDACs) with mass lesions detected on imaging studies.
In our hospital, the cell-block method has been used for cytological evaluation of pancreatobiliary diseases because this method allows many kinds of histological staining, including immunostaining, to be performed simultaneously, even by using cytological specimens, thereby enabling more accurate and objective diagnoses of malignancies, such as histological diagnoses.
Recently, we have adopted pancreatic duct lavage cytology combined with a cell-block method (PLC-CB), mainly by using a double lumen catheter for patients with possible malignant intraductal papillary mucinous neoplasms
This was a retrospective, single-center, cross-sectional study conducted at Sendai City Medical Center. In our hospital, histocytological evaluations using pancreatic specimens, including pancreatic juice, are performed if patients have any one of the following: a pancreatic mass, focal main pancreatic duct (MPD) stenosis lacking secondary etiology of this finding, such as chronic pancreatitis, or focal pancreatic parenchymal atrophy replaced by fatty tissues. For patients with the above-mentioned indications, EUS-FNA (or transpapillary bile duct biopsy) is first performed if pancreatic masses are detected on imaging. On the other hand, PCL-CB is performed when the following situations occur: (1) patients do not have visible pancreatic masses; (2) EUS-FNA is technically difficult to perform; (3) patients refuse to undergo EUS-FNA because of the possibility of dissemination of tumor cells; and (4) PCL-CB is complementarily performed in addition to EUS-FNA for the purpose of improving diagnostic accuracy in detecting malignancy.
A flowchart of this study is presented in
We retrospectively evaluated the following: (1) the success rate of histocytological evaluations using PLC-CB, (2) the accuracy of PLC-CB for detecting malignancy, (3) the accuracy of PLC-CB in detecting malignancy in patients with possible PDACs in whom pancreatic masses were not detected using EUS, and (4) postprocedural adverse events.
Pancreatography was performed using a duodenoscope (JF-260V or TJF-260V; Olympus) and a 1.7 mm diameter cannula (PR-104Q-1 or PR-109Q-1; Olympus). A 0.025-inch J-shaped tip guidewire (Revowave SJ; Piolax Medical Devices Inc.) was carefully advanced into the tail side of the MPD, and then the cannula was changed to the following sampling catheters over the guidewire: a single lumen catheter with side holes (PR-130Q; Olympus) or a double lumen catheter (Uneven Double Lumen Cannula; Piolax Medical Devices Inc.) (
All collected fluid specimens were used for histocytological evaluations using the cell-block method. Cell block sections were processed using the sodium alginate method and subjected to hematoxylin and eosin (H&E) staining for all subjects and immunostaining, if necessary.
The findings obtained from H&E staining were first used for the evaluation of PLC-CB specimens, and malignancy was defined as Class IIIb–V on the basis of the Papanicolaou classification system.
For patients who underwent pancreatic surgery, definitive malignancy was determined as having histologically confirmed PDACs, including pancreatic carcinoma
Adverse events associated with endoscopic retrograde cholangiopancreatography (ERCP), such as post-ERCP pancreatitis (PEP), perforation, bleeding, and adverse events related to the cardiovascular and pulmonary systems, were evaluated in all subjects. The diagnosis and severity of PEP were determined based on criteria developed by Cotton et al.
All statistical analyses were performed using the JMP software (JMP 10; SAS Institute Inc.). The distribution of variables is shown as an interquartile range (IQR).
The study protocol was approved by the ethics committee of Sendai City Medical Center (registration number: 2019-42). Informed consent for endoscopic procedures was obtained from all patients.
Nineteen men and 22 women with a median age of 70 years (IQR, 64–76 years) were included in this study. Imaging studies showed that 17 patients (41.5%) had pancreatic masses with a median size of 21 mm (IQR, 12–40 mm), and nine of these patients underwent EUS-FNA for tissue acquisition (histological diagnoses of EUS-FNA specimens: malignancy, 3; indeterminate diagnosis, 6). Of the nine patients, five underwent EUS-FNA for initial tissue acquisition. The remaining four patients underwent EUS-FNA for additional tissue acquisition a few days after undergoing PLC-CB to improve the diagnostic accuracy for detecting malignancy by using specimens obtained endoscopically at the physician’s discretion. On the other hand, 8 of the 17 patients with pancreatic masses initially underwent PLC-CB for initial tissue acquisition for the following reasons: (1) difficulty in undergoing EUS-FNA due to poor visualization of their pancreatic masses using EUS (
Definitive diagnoses of PDACs were made in 18 patients (invasive,
A double lumen catheter was used in 88% (
Of the 36 patients whose fluid specimens could be evaluated histocytologically, 16 were diagnosed with malignancy using the initial PLC-CB. Of these 16 patients, 15 underwent surgery and the remaining patients underwent preoperative chemotherapy. All 15 patients who underwent surgery were definitively diagnosed with malignancy by using resected pancreatic specimens (invasive PDAC,
Of the 20 patients diagnosed with benignancy using initial PLC-CB, two underwent pancreatic surgery after initial PLC-CB in consideration of the possibility of false-negative results due to MPD stenosis with marked dilation of the upstream MPD. Both patients were diagnosed with low-grade pancreatic intraepithelial neoplasia (PanIN) by using resected specimens. Of the 18 patients who underwent surveillance without surgery depending on the PLC-CB results of benignancy, 12 were determined to be benign based on imaging findings and clinical courses during a surveillance period of ≥12 months after PLC-CB (median surveillance period after initial PLC-CB, 641 days (IQR, 494–1,084 days); benign MPD stenosis,
Of the 41 patients who underwent PLC-CB, five were excluded from the evaluation of the diagnostic ability to detect malignancy due to lack of surveillance periods after PLC-CB, and the accuracy of PLC-CB for detecting malignancy was evaluated using 36 patients whose final diagnoses could be determined (
First, from 36 patients with definitive diagnoses, we selected 31 patients with adequate PLC-CB specimens to investigate the diagnostic ability of PLC-CB to detect malignancy. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy in detecting malignancy were 94.1% (16/17), 100% (14/14), 100% (16/16), 93.3% (14/15), and 96.8% (30/31), respectively. For one patient whose diagnosis of initial PLC-CB was determined to be a false negative (Class II), a pancreatic mass lesion was detected three months after initial PLC-CB, followed by a diagnosis of malignancy using secondary PLC-CB (Class V) and EUS-FNA (adenocarcinoma).
Of the 31 patients, 17 had no visible pancreatic masses detected using EUS (final diagnosis: invasive PDAC, 3; PCIS, 5; low-grade PanIN, 1; benign MPD stenosis, 8). For the 17 patients, the sensitivity, specificity, PPV, NPV, and accuracy of PLC-CB for detecting malignancy were 87.5% (7/8), 100% (9/9), 100% (7/7), 90.0% (9/10), and 94.1% (16/17), respectively. Eight of the 17 patients were diagnosed with PDACs using resected specimens, and the final stages on the basis of the 8th edition of the Union for International Cancer Control were stage 0 in five patients and IA in three patients (T1b,
In addition, we investigated the diagnostic ability of PLC-CB to detect malignancy in all 36 patients with definitive diagnoses, including five patients with inadequate PLC-CB specimens. In this situation, regardless of which final diagnoses were made for five patients with inadequate PLC-CB specimens, the diagnoses of PLC-CB for those five patients were regarded as incorrect. Thus, when all 36 patients were included in this analysis, the sensitivity, specificity, PPV, NPV, and accuracy of PLC-CB for detecting malignancy were calculated as 88.9% (16/18), 77.8% (14/18), 100% (16/16), 93.3% (14/15), and 83.3% (30/36), respectively. When 21 patients without visible imaging mass lesions were selected from the 36 patients for the evaluation of the sensitivity, specificity, PPV, NPV, and accuracy of PLC-CB in detecting malignancy, they were calculated to be 87.5% (7/8), 69.2% (9/13), 100% (7/7), 90.0% (9/10), and 76.2% (16/21), respectively.
For 35 subjects (85.4%), prophylactic pancreatic stenting using a 5 Fr, one-sided pigtail-type pancreatic stent (Pit-stent; Gaderius Medical Co., Tokyo, Japan) was performed. In addition, nonsteroidal anti-inflammatory drugs (NSAIDs; diclofenac sodium suppository, 25 or 50 mg/body) were administered before ERCP as a preventative measure in 23 of the subjects (56.1%) (
PEP developed in four patients (9.8%; moderate severity, 3; mild severity, 1). Of the four patients with PEP, one patient with moderate PEP did not undergo pancreatic stent replacement and administration of NSAIDs, whereas the remaining three underwent both prophylactic treatments. The PEP in these patients improved with conservative treatment. No other adverse events associated with ERCP were observed in any of the patients.
To clarify the risk factors for PEP related to PLC-CB procedures, we investigated the relationship between PEP and the following factors: sex, body mass index, NSAID administration, pancreatic duct stent placement, sphincterotomy, intraductal ultrasound, and total amount of injected saline, as shown in
This study indicates that PLC-CB can be used to detect malignancy in patients with possible PDACs for which EUS-FNA is inadequate, with a high sensitivity for detecting malignancy and a relatively acceptable rate of PEP. Since EUS-FNA is sometimes ineffective for patients with early stage PDACs, including PCIS, because of the lack of target pancreatic masses, PLC-CB may be a promising method for these patients in consideration of the high diagnostic accuracy of this method.
The methodology in this study was characterized by the use of a combination of pancreatic duct lavage and cell-block methods. There have been no reports on the diagnostic ability of the pancreatic duct lavage method for detecting malignancy in patients with PDAC. In this study, a commercially available double lumen catheter was mainly used for the pancreatic duct lavage method. This catheter allowed us to perform injection and suction simultaneously, and larger volumes of fluid specimens were obtained (a median of 40 mL). However, this method is not suitable for cytological evaluation using the smear method because the fluid specimens obtained using this method are too large to be evaluated. We believe that the cell-block method is an optimal choice for evaluating larger volumes of fluid specimens histocytologically, and that the pancreatic duct lavage and cell-block methods make a good combination. In addition, the cell-block method enables us to evaluate structural atypia and many types of immunostaining, even for pancreatic juice specimens, contributing to a more objective and accurate diagnosis of malignancy in patients with possible PDACs.
With regard to recent studies for the diagnosis of PCIS, the utility of serial pancreatic juice aspiration for cytologic examination using an endoscopic nasopancreatic drainage (ENPD) catheter has been reported.
This study had several limitations. First, it had a small sample size and was a retrospective study conducted in a single medical center. Therefore, the results of this study need to be verified in a multicenter, large-sample validation cohort. Second, the surveillance period after PLC-CB is relatively short. As it can take several years for PCISs to develop invasive lesions,
In conclusion, PLC-CB has a good ability to detect malignancy for possible PDACs without visible pancreatic masses or those for which EUS-FNA is technically difficult. A transpapillary approach using PLC-CB may contribute to the detection of early stage PDACs, including PCIS, for which good prognosis can be expected.
The authors have no potential conflicts of interest.
None.
We would like to thank Fumiyoshi Fujishima, MD, PhD, Department of Pathology, Tohoku University School of Medicine, Miwa Uzuki, MD, PhD, Department of Nursing, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, and Toru Furukawa, MD, PhD, Department of Investigative Pathology, Tohoku University Graduate School of Medicine for histocylogical evaluations using cytological specimens and resected specimens from all subjects, and all staff in the Department of Pathology at Sendai City Medical Center for performing immunohistochemical staining in this study. In addition, we are grateful to Dr. Brian Breedlove, Associate Professor, Tohoku University School of Science, for English proofreading.
Conceptualization: HK, SK; Data curation: HK, SK; Formal analysis: HK, SK, TT, TSaw, YN, KI; Investigation: HK, SK, YK, TO, TSak, KY, KM, FK, HA, KE, HO, MO; Methodology: HK, SK; Project administration: HK, SK; Supervision: SK, KI; Validation: SK, KI; Writing–original draft: HK, SK; Writing–review & editing: all authors.
Flowchart for patient selection in this study. PDACs, pancreatic ductal adenocarcinomas; EUS-FNA, endoscopic ultrasound-guided fine needle aspiration; PLC-CB, pancreatic duct lavage cytology combined with a cell-block method.
Tip of a double lumen sampling catheter used in this study (Uneven Double Lumen Cannula; Piolax Medical Devices Inc.).
Endoscopic procedure for pancreatic duct lavage cytology by using a double lumen catheter (endoscopy assistant). The injection of saline into the main pancreatic duct (A) and the suction of fluid in the main pancreatic duct with negative pressure by using a syringe (B) were simultaneously performed through two separate lumens (0.025- and 0.035-inch lumen, respectively).
A 64-year-old patient with an initial diagnosis of acute pancreatitis (patient no. 14 in
An 82-year-old patient (patient no. 17 in
Baseline characteristics of 41 patients included in this study
Characteristic | Patients (n = 41) |
---|---|
Age (yr) | 70 (64–76) |
Sex (male:female) | 19:22 |
Symptoms | |
Abdominal pain | 14 (34.1) |
Chest pain | 1 (2.4) |
Back pain | 1 (2.4) |
Body weight loss | 1 (2.4) |
Jaundice | 1 (2.4) |
No symptoms | 23 (56.1) |
Serum CA19-9 levels (U/mL) | 15 (5–47) |
Image findings | |
Mass lesions | 17 (41.5) |
Size of mass lesion (mm) ( |
21 (12–40) |
MPD stenosis | 37 (90.2) |
Focal atrophy of pancreatic parenchyma | 11 (26.8) |
Location of main lesions (Ph/Pb/Pt) | 11/16/14 |
Tissue acquisition before/after undergoing PLC-CB | |
EUS-FNA | 9 (22.0) |
None | 32 (78.0) |
Final diagnoses | |
PDAC | 18 (43.9) |
Invasive | 13 (31.7) |
PCIS | 5 (12.2) |
Benign MPD stenosis | 12 (29.3) |
Low-grade PanIN | 2 (4.9) |
Autoimmune pancreatitis | 1 (2.4) |
Mass-forming pancreatitis | 3 (7.3) |
Indeterminate diagnosis due to lack of surveillance periods after PLC-CB | 5 (12.2) |
TNM stage (UICC 8th ed.), of the PDAC (n=18) | |
0 | 5 (27.8) |
IA | 4 (22.2) |
IB | 4 (22.2) |
IIA | 2 (11.1) |
IIB | 2 (11.1) |
III | 1 (5.6) |
Clinical courses after PLC-CB | |
Surgery | 16 (39.0) |
Surgery after surveillance | 3 (7.3) |
Surveillance | 21 (51.2) |
Systemic chemotherapy | 1 (2.4) |
Values are presented as median (interquartile range) or number (%). MPD, main pancreatic duct; Ph, pancreatic head; Pb, pancreatic body; Pt, pancreatic tail; PLC-CB, pancreatic duct lavage cytology combined with a cell block method; EUS-FNA, endoscopic ultrasound-guided fine needle aspiration; PDAC, pancreatic ductal adenocarcinomas; PCIS, pancreatic carcinoma
Demographic, procedural, and histocytological data for the respective 41 patients who underwent pancreatic duct lavage cytology combined with the cell-block method
Case | Age (yr) | Sex | Imaging for diagnosis | Imaging findings |
Performance of EUS-FNA before/after PLC-CB | Catheter used for PLC-CB | Total amount of injected saline (mL) | Total amount of fluid specimens obtained (mL) | Reults of PLC-CB (Class) | Treatments after PLC-CB | Surveillance period after initial PLC-CB (day) | Final diagnoses | Stages of the PDAC (UICC 8th ed.) | PEP (severity) | Administration of NSAIDs (mg) | Prophylactic pancreatic stent | ||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mass (size, mm) | MPD stenosis | Pancreatic atrophy | ||||||||||||||||
1 | 81 | F | EUS, CT, MRI, US | + (30) | Ph | − | + (after PLC-CB) | Double lumen | 40 | 60 | V | Surgery | N/A | Invasive PDAC | ⅡB (T2N1) | − | − | − |
2 | 70 | M | EUS, CT, MRI | + (10) | Ph | − | + (after PLC-CB) | Single lumen | 4 | 4 | V | Surgery | N/A | Invasive PDAC | ⅠA (T1cN0) | − | 50 | + |
3 | 66 | M | EUS, CT, MRI, US | + (21) | Ph | − | − | Double lumen | 35 | 45 | V | Surgery | N/A | Invasive PDAC | ⅡA (T3N0) | − | − | − |
4 | 64 | M | EUS, CT, MRI, US | + (21) | Pt | − | − | Double lumen | 40 | 12 | V | Surgery | N/A | Invasive PDAC | ⅠB (T2N0) | − | − | + |
5 | 73 | M | EUS, MRI | − | Ph | − | − | Double lumen | 30 | 35 | IV | Surgery | N/A | Invasive PDAC | ⅠA (T1bN0) | − | − | − |
6 | 68 | F | EUS, CT, MRI | + (19) | Pb | Pb | − | Double lumen | 40 | 40 | IIIb | Surgery | N/A | Invasive PDAC | ⅠB (T2N0) | − | − | + |
7 | 64 | M | EUS, CT, MRI, US | + (68) | Pt | − | − | Double lumen | 10 | 15 | IIIb | Surgery | N/A | Invasive PDAC | Ⅲ (T3N2) | − | − | + |
8 | 63 | M | EUS, CT, MRI, US | + (26) | Ph | − | − | Double lumen | 40 | 40 | IIIb | Surgery | N/A | Invasive PDAC | ⅠB (T2N0) | − | − | + |
9 | 72 | F | EUS, CT, MRI, US | + (7) | Ph | − | + (after PLC-CB) | Double lumen | 57 | 60 | IIIb | Surgery | 134 | Invasive PDAC | IIB (T1bN1) | − | − | + |
10 | 74 | M | EUS, CT, MRI, US | − | Pt | − | − | Double lumen | 30 | 40 | IIIb | Surgery | N/A | Invasive PDAC | ⅠA (T1bN0) | − | 50 | + |
11 | 70 | M | EUS, CT | + (35) | Pb | Pt | − | Single lumen | N/A | N/A | IIIb | Chemotherapy | 79 | Invasive PDAC | ⅠB (T2N0) | − | 50 | + |
12 | 83 | F | EUS, CT, MRI | − | Pt | Pt | − | Double lumen | 10 | 15 | II | Surgery | 91 | Invasive PDAC | ⅠA (T1cN0) | − | − | + |
13 | 62 | F | EUS, CT, MRI, US | + (46) | Ph | − | + (before PLC-CB) | Single lumen | N/A | 5 | Inadequate specimens | Surgery | N/A | Invasive PDAC | ⅡA (T3N0) | − | 50 | + |
14 | 64 | M | EUS, CT, MRI | − | Pt | Pt | − | Double lumen | 30 | 30 | V | Surgery | N/A | PCIS | 0 (Tis) | − | − | + |
15 | 66 | M | EUS, MRI, US | − | Pb | Pb | − | Double lumen | 30 | 40 | IV | Surgery | N/A | PCIS | 0 (Tis) | + (mild) | 50 | + |
16 | 61 | F | EUS, CT, MRI, US | − | Pt | − | − | Single lumen | 40 | 50 | IV | Surgery | N/A | PCIS | 0 (Tis) | + (moderate) | − | − |
17 | 82 | F | EUS, CT | − | Pb | Pb | − | Double lumen | 40 | 45 | IV | Surgery | N/A | PCIS | 0 (Tis) | − | 100 | + |
18 | 68 | F | EUS, CT, MRI, US | − | Ph | Ph | − | Double lumen | 40 | 40 | IIIb | Surgery | N/A | PCIS | 0 (Tis) | − | 50 | + |
19 | 87 | F | EUS, CT, MRI | + (20) | Ph | − | + (before PLC-CB) | Double lumen | 30 | 30 | II | Surgery | 82 | Low-grade PanIN | N/A | − | 25 | + |
20 | 79 | F | EUS, CT, MRI, US | − | Pb | Pb | − | Double lumen | 43 | 45 | II | Surgery | N/A | Low-grade PanIN | N/A | + (moderate) | 50 | + |
21 | 72 | M | EUS, CT, MRI, US | + (44) | Pt | − | + (after PLC-CB) | Double lumen | 60 | 65 | II | Follow-up | 1189 | MFP | N/A | − | − | + |
22 | 77 | F | EUS, CT, MRI, US | + (13) | - | Pt | + (before PLC-CB) | Double lumen | 6 | 3 | II | Follow-up | 377 | MFP | N/A | − | 25 | − |
23 | 63 | F | EUS, CT, MRI, US | + (5) | Pb | − | − | Double lumen | 31 | 35 | II | Follow-up | 386 | MFP | N/A | − | 50 | + |
24 | 67 | M | EUS, CT, MRI, US | + (53) | Pb | − | + (before PLC-CB) | Single lumen | N/A | 8 | I | Follow-up | 488 | AIP | N/A | − | 50 | + |
25 | 83 | M | EUS, CT, MRI, US | − | Pb | Pb | − | Double lumen | 4 | N/A | II | Follow-up | 673 | Benign MPD stenosis | N/A | − | 25 | + |
26 | 74 | F | EUS, CT, MRI, US | − | Pt | − | − | Double lumen | 40 | 40 | II | Follow-up | 1216 | Benign MPD stenosis | N/A | − | − | + |
27 | 73 | F | EUS, CT, MRI | − | Ph | − | − | Double lumen | 20 | 20 | II | Follow-up | 911 | Benign MPD stenosis | N/A | − | − | − |
28 | 70 | F | EUS, CT, MRI, US | − | - | − | − | Double lumen | N/A | N/A | II | Follow-up | 570 | Benign MPD stenosis | N/A | − | 50 | + |
29 | 61 | M | EUS, MRI | − | Ph | − | − | Double lumen | 3 | N/A | II | Follow-up | 657 | Benign MPD stenosis | N/A | − | 50 | + |
30 | 58 | M | EUS, MRI, US | − | - | − | − | Double lumen | 40 | 40 | II | Follow-up | 1142 | Benign MPD stenosis | N/A | − | − | + |
31 | 40 | M | EUS, CT, MRI, US | − | Pb | − | − | Double lumen | 9 | 9 | II | Follow-up | 511 | Benign MPD stenosis | N/A | − | 50 | + |
32 | 45 | M | EUS, CT, MRI | − | Pt | − | − | Double lumen | 15 | N/A | I | Follow-up | 624 | Benign MPD stenosis | N/A | − | 50 | + |
33 | 72 | F | EUS, CT, MRI, US | − | Pt | − | − | Double lumen | 40 | 35 | Inadequate specimens | Follow-up | 496 | Benign MPD stenosis | N/A | − | 50 | + |
34 | 71 | F | EUS, CT, MRI, US | − | Pt | − | − | Double lumen | 50 | 45 | Inadequate specimens | Follow-up | 770 | Benign MPD stenosis | N/A | − | − | + |
35 | 64 | F | CT, MRI, US | − | Pt | − | − | Double lumen | 50 | 50 | Inadequate specimens | Follow-up | 931 | Benign MPD stenosis | N/A | − | − | + |
36 | 64 | F | EUS, CT, MRI, US | − | Pt | − | − | Double lumen | N/A | N/A | Inadequate specimens | Follow-up | 617 | Benign MPD stenosis | N/A | − | 50 | + |
37 | 76 | F | EUS, CT, MRI, US | + (18) | - | − | − | Double lumen | 80 | 75 | II | Follow-up | 147 | Indeterminatea) | N/A | − | − | + |
38 | 82 | M | CT, MRI, US | − | Pb | − | − | Double lumen | 15 | 12 | II | Follow-up | 288 | Indeterminatea) | N/A | − | 25 | + |
39 | 81 | M | EUS, CT, MRI, US | − | Pt | − | − | Double lumen | 50 | 40 | II | Follow-up | 0 | Indeterminatea) | N/A | − | 25 | + |
40 | 75 | F | EUS, CT, MRI, US | + (8) | Pb | Pb | + (before PLC-CB) | Double lumen | 40 | 35 | II | Follow-up | 339 | Indeterminatea) | N/A | − | 50 | + |
41 | 75 | F | EUS, CT, MRI, US | − | Pb | − | − | Double lumen | 38 | 38 | II | Follow-up | 288 | Indeterminatea) | N/A | + (moderate) | 50 | + |
MPD, main pancreatic duct; EUS-FNA, endoscopic ultrasound-guided fine needle aspiration; PLC-CB, pancreatic duct lavage cytology combined with a cell-block method; PDAC, pancreatic ductal adenocarcinoma; UICC, Union for International Cancer Control; PEP, post-endoscopic retrograde cholangiopancreatography pancreatitis; NSAIDs, non-steroidal anti-inflammatory drugs; F, female; M, male; EUS, endoscopic ultrasonography; CT, computed tomography; MRI, magnetic resonance imaging; US, ultrasonography; Ph, pancreatic head; Pt, pancreatic tail; Pb, pancreatic body; N/A, not available; PCIS, pancreatic carcinoma
a)Indeternimate final diagnosis due to lack of surveillance periods (<12 months) after undergoing PLC-CB.
Diagnostic ability of PLC‐CB to detect malignancy
Diagnostic ability of PLC‐CB to detect malignancy |
||||||
---|---|---|---|---|---|---|
Sensitivity | Specificity | PPV | NPV | Accuracy | ||
31 Patients with adequate PLC‐CB specimens | All patients ( |
16/17 (94.1%) | 14/14 (100%) | 16/16 (100%) | 14/15 (93.3%) | 30/31 (96.8%) |
Patients without masses ( |
7/8 (87.5%) | 9/9 (100%) | 7/7 (100%) | 9/10 (90.0%) | 16/17 (94.1%) | |
36 Patients, including 5 patients with inadequate PLC‐CB specimens | All patients ( |
16/18 (88.9%) | 14/18 (77.8%) | 16/16 (100%) | 14/15 (93.3%) | 30/36 (83.3%) |
Patients without masses ( |
7/8 (87.5%) | 9/13 (69.2%) | 7/7 (100%) | 9/10 (90.0%) | 16/21 (76.2%) |
PLC-CB, pancreatic duct lavage cytology combined with a cell block method.
Possible risk factors for developing PEP
Case | Age (yr) | Sex | PEP (severity) | BMI (kg/m2) | Total procedure time (min) | Administration of NSAIDs (mg) | Prophylactic pancreatic stent | Sphincterotomy (EST, EPST) | IDUS | Surgically altered anatomy |
---|---|---|---|---|---|---|---|---|---|---|
1 | 81 | F | − | 21.2 | 36 | − | − | − | − | − |
2 | 70 | M | − | 24.9 | 23 | 50 | + | − | − | − |
3 | 66 | M | − | 19.8 | 12 | − | − | − | − | − |
4 | 64 | M | − | 21.3 | 15 | − | + | − | − | − |
5 | 73 | M | − | 23.1 | 26 | − | − | − | − | − |
6 | 68 | F | − | 20.1 | 33 | − | + | − | − | − |
7 | 64 | M | − | 26.1 | 28 | − | + | − | − | − |
8 | 63 | M | − | 29.2 | 38 | − | + | − | − | − |
9 | 72 | F | − | 19.7 | 24 | − | + | − | − | − |
10 | 74 | M | − | 18.7 | 27 | 50 | + | − | − | − |
11 | 70 | M | − | 23.3 | 62 | 50 | + | − | − | − |
12 | 83 | F | − | 23.2 | 24 | − | + | − | − | − |
13 | 62 | F | − | 27.6 | 72 | 50 | + | − | − | − |
14 | 64 | M | − | 24.6 | 47 | − | + | − | − | − |
15 | 66 | M | + (mild) | 16.1 | 96 | 50 | + | − | − | TGRY |
16 | 61 | F | + (moderate) | 24.2 | 54 | − | − | − | − | − |
17 | 82 | F | − | 21.9 | 38 | 100 | + | + | − | − |
18 | 68 | F | − | 21.2 | 31 | 50 | + | − | − | − |
19 | 87 | F | − | 21.1 | 46 | 25 | + | − | − | − |
20 | 79 | F | + (moderate) | 21.7 | 35 | 50 | + | − | − | − |
21 | 72 | M | − | 18.4 | 25 | − | + | + | − | DGBI |
22 | 77 | F | − | 24.6 | 24 | 25 | − | − | − | − |
23 | 63 | F | − | 20.3 | 28 | 50 | + | − | − | − |
24 | 67 | M | − | 25.5 | 14 | 50 | + | − | − | − |
25 | 83 | M | − | 25.6 | 19 | 25 | + | − | − | − |
26 | 74 | F | − | 28.6 | 28 | − | + | − | − | − |
27 | 73 | F | − | 23.7 | 35 | − | − | − | − | − |
28 | 70 | F | − | 20.5 | 80 | 50 | + | + | − | − |
29 | 61 | M | − | 24.9 | 73 | 50 | + | + | + | − |
30 | 58 | M | − | 24.8 | 36 | − | + | − | − | − |
31 | 40 | M | − | 31.5 | 38 | 50 | + | − | − | − |
32 | 45 | M | − | 22.4 | 36 | 50 | + | − | − | − |
33 | 72 | F | − | 21.1 | 32 | 50 | + | − | − | − |
34 | 71 | F | − | 35.7 | 33 | − | + | − | − | − |
35 | 64 | F | − | 26.5 | 36 | − | + | − | − | − |
36 | 64 | F | − | 22.3 | 33 | 50 | + | − | − | − |
37 | 76 | F | − | 32.2 | 40 | − | + | + | − | − |
38 | 82 | M | − | 23.6 | 25 | 25 | + | − | − | − |
39 | 81 | M | − | 29.3 | 39 | 25 | + | − | − | − |
40 | 75 | F | − | 19.3 | 24 | 50 | + | − | − | − |
41 | 75 | F | + (moderate) | 19.7 | 42 | 50 | + | − | − | − |
PEP, post-endoscopic retrograde cholangiopancreatography pancreatitis; BMI, body mass index; NSAIDs, non-steroidal anti-inflammatory drugs, EST, endoscopic sphincterotomy; EPST, endoscopic pancreatic sphincterotomy; IDUS, intraductal ultrasonography; F, female; M, male; TGRY, total gastrectomy with Roux-en-Y reconstruction; DGBI, distal gastrectomy with Billroth I reconstruction.