Year 2018 / Volume 110 / Number 12
Original
The role of pancreatic juice cytology in the diagnosis of pancreatic intraductal papillary mucinous neoplasm

775-781

DOI: 10.17235/reed.2018.5564/2018

Mohammed Tag-Adeen, Eisuke Ozawa, Kumi Ogihara, Shinichi Iwatsu, Yuko Akazawa, Ken Ohnita, Tomohiko Adachi, Yorihisa Sumida, Kazuhiko Nakao,

Abstract
Background and aim: pancreatic juice cytology (PJC) is an important predictor of malignant intraductal papillary mucinous neoplasm (IPMN). This study aimed to determine the role of PJC for the prediction of malignant IPMN (intraductal papillary mucinous cancer [IPMC]). Methods: medical records of IPMN patients who underwent surgery between 2012 and 2016 at the Nagasaki University Hospital were reviewed. Patients who underwent preoperative PJC were classified as high risk stigmata (HRS), worrisome features (WF) and no-criteria, based on imaging criteria. PJC class III or higher was considered as positive and only invasive IPMN was defined as IPMC. PJC was validated in each group with regard to sensitivity, specificity, accuracy with the corresponding 95% confidence intervals (95% CI) and area under receiver operating curve (AUROC) analysis. A p-value of < 0.05 was considered as statistically significant. Results: preoperative pancreatic juice was obtained in 33/52 IPMN patients; only patients with adequate aspirate for cytology (n = 29) were included. In the HRS group (n = 9), 4/6 non-IPMC had a negative PJC and 3/3 IPMC had a positive PJC. In the WF group (n = 17), 9/11 non-IPMC had a negative PJC and 3/6 IPMC had a positive PJC. Adding PJC to imaging results improved the AUROCs of HRS and WF from 0.63 and 0.62 to 0.83 and 0.66, respectively. PJC was negative in all no-criteria cases (n = 3; one IPMC and two non-IPMC). In all 29 patients, PJC sensitivity was 60% (95% CI: 26%-88%), specificity was 79% (95% CI: 54%-94%), accuracy was 72% (95% CI: 63%-89%) and the AUROC was 0.69 (p = 0.03). Conclusion: PJC is a statistically significant IPMC predictor that can improve the validity of imaging for IPMC prediction.
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References
1. Grutzmann R, Post S, Saeger HD, Niedergethmann M. Intraductal papillary mucinous neoplasia (IPMN) of the pancreas: its diagnosis, treatment, and prognosis. Dtsch Arztebl Int 2011; 108:788-94.
2. Swartz MJ, Hsu CC, Pawlik TM, et al. Adjuvant chemoradiotherapy after pancreatic resection for invasive carcinoma associated with intraductal papillary mucinous neoplasm of the pancreas. Int J Radiat Oncol Biol Phys 2010; 76:839-44.
3. Tanaka M, Fernandez-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012; 12:183-97.
4. Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006; 6:17-32.
5. Kim KW, Park SH, Pyo J, et al. Imaging features to distinguish malignant and benign branch-duct type intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis. Ann Surg. 2014; 259:72–81.
6. Rei Suzuki, Nirav Thosani, Srinadh Annangi, et al. Diagnostic yield of endoscopic retrograde cholangiopancreatography-based cytology for distinguishing malignant and benign intraductal papillary mucinous neoplasm: Systematic review and meta-analysis. Digestive Endoscopy 2014; 26: 586–593.
7. Uehara H, Ishikawa O, Katayama K, et al. Size of mural nodule as an indicator of surgery for branch duct intraductal papillary mucinous neoplasm of the pancreas during follow-up. J Gastroenterol 2011 May;46(5):657e63.
8. Uehara H, Ishikawa O, Ikezawa K, et al. A natural course of main duct intraductal papillary mucinous neoplasm of the pancreas with lower likelihood of malignancy. Pancreas 2010 Jul;39(5): 653e7.
9. Kawada N, Uehara H, Nagata S, et al. Predictors of malignancy in branch duct intraductal papillary mucinous neoplasm of the pancreas. JOP 2014;15(5):459e64.
10. Yamaguchi K, Nakamura M, Shirahane K, et al. Pancreatic Juice Cytology in IPMN of the Pancreas. Pancreatology 2005;5: 416–421.
11. Adsay NV, Fukushima N, Furukawa T, et al. Intraductal neoplasm of the pancreas. In: Bosman FT, Carneiro F, Hruban RH, Theise ND, editors. WHO classification of tumors of digestive system. Lyon: WHO Press; 2010; 304-13.
12. Jang JY, Park T, Lee S, et al. Validation of international consensus guidelines for the resection of branch duct-type intraductal papillary mucinous neoplasms. BJS 2014; 101: 686–692.
13. Nagai K, Doi R, Ito T, et al. Single-institution validation of the international consensus guidelines for treatment of branch duct intraductal papillary mucinous neoplasms of the pancreas. J Hepatobiliary Pancreat Surg 2009; 16: 353–358.
14. Brian K, Zhimin L, Damien M, et al. Evaluation of the Fukuoka Consensus Guidelines for intraductal papillary mucinous neoplasms of the pancreas: Results from a systematic review of 1,382 surgically resected patients. Surgery 2015;158: 1192-202.
15. Fritz S, Hackert T, Hinz U, et al. Role of serum carbohydrate 19-9 and carcinoembryonic antigen in distinguishing between benign and invasive intraductal papillary mucinous neoplasm of the pancreas. Br J Surg 2011; 98:104-10.
16. Freeny PC, Saunders MD. Moving beyond morphology: new insights into the characterization and management of cystic pancreatic lesions. Radiology 2014; 272:345-63.
17. Arima K, Okabe H, Hashimoto D, et al. The Neutrophil-to-Lymphocyte Ratio Predicts Malignant Potential in Intraductal Papillary Mucinous Neoplasms. J Gastrointest Surg 2015; 19:2171–2177.
18. Goh B, Teo JY, Allen JC, et al. Preoperative platelet-to-lymphocyte ratio improves the performance of the international consensus guidelines in predicting malignant pancreatic cystic neoplasms. Pancreatology 2016; 16, 888-892.
19. Hibi Y, Fukushima N, Tsuchida A, et al. Pancreatic Juice Cytology and Sub-classification of Intraductal Papillary Mucinous Neoplasms of the Pancreas. Pancreas 2007; 34:197-204.
20. Kawada N, Uehara H, Nagata S, et al. Pancreatic juice cytology as sensitive test for detecting pancreatic malignancy in intraductal papillary mucinous neoplasm of the pancreas without mural nodule. Pancreatology 2016; xxx: 1-6.
21. Ohtsuka T, Matsunaga T, Kimura H, et al. Role of Pancreatic Juice Cytology in the Preoperative Management of Intraductal Papillary Mucinous Neoplasm of the Pancreas in the Era of International Consensus Guidelines. World J Surg 2014; 38:2994–3001.
22. Sai JK, Nobukawa B, Matsumura Y, Watanabe S. Pancreatic duct lavage cytology with the cell block method for discriminating benign and malignant branch-duct type intraductal papillary mucinous neoplasms. Gastrointest Endosc 2013; 77:726-35.
23. Hirono S, Tani M, Kawai M, et al. The carcinoembryonic antigen level in pancreatic juice and mural nodule size are predictors of malignancy for branch duct type intraductal papillary mucinous neoplasms of the pancreas. Ann. Surg. 2012; 255: 517–22.
24. Kondo H, Sugano K, Fukayama N, et al. Detection of K-ras gene mutations at codon 12 in the pancreatic juice of patients with intraductal papillary mucinous tumors of the pancreas. Cancer 1997; 79:900-5.
25. Jiang P, Watanabe H, Okada G, et al. Diagnostic utility of aberrant methylation of tissue factor pathway inhibitor 2 in pure pancreatic juice for pancreatic carcinoma. Cancer Sci 2006;97: 1267-73.
26. Watanabe H, Okada G, Ohtubo K, et al. Expression of mesothelin mRNA in pure pancreatic juice from patients with pancreatic carcinoma, intraductal papillary mucinous neoplasm of the pancreas, and chronic pancreatitis. Pancreas 2005; 30:349-54.
27. Shimamoto T, Tani M, Kawai M, et al. MUC1 is a useful molecular marker for malignant intraductal papillary mucinous neoplasms in pancreatic juice obtained from endoscopic retrograde pancreatography. Pancreas 2010; 39: 879–83.
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Tag-Adeen M, Ozawa E, Ogihara K, Iwatsu S, Akazawa Y, Ohnita K, et all. The role of pancreatic juice cytology in the diagnosis of pancreatic intraductal papillary mucinous neoplasm. 5564/2018


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Publication history

Received: 27/02/2018

Accepted: 05/06/2018

Online First: 28/08/2018

Published: 03/12/2018

Article revision time: 92 days

Article Online First time: 182 days

Article editing time: 279 days


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