目的:直径≤10mm的胰腺导管腺癌(PDAC)和高度胰腺上皮内瘤变(HG-PanIN)需要术前诊断。大多数病例在内窥镜超声(EUS)上仅表现出间接影像学发现,而没有可见的肿瘤。因此,EUS引导的细针抽吸/活检不适用。另一种诊断方法是通过内窥镜鼻胰腺引流(ENPD-PJC)进行胰液细胞学(PJC)。这不是标准的做法。本研究旨在研究ENPD-PJC在EUS上无可见肿瘤的可疑PDAC/HG-PanIN病例中的诊断。
方法:回顾性评估怀疑患有PDAC/HG-PanIN且无可见肿瘤的患者接受PJC的数据。在内镜逆行胰管造影术(ERP-PJC)期间收集了一个PJC样本,在ENPD-PJC期间收集了12个样本,3小时用于细胞学分析。ERP-PJC,ERP/ENPD-PJC,ENPD-PJC阳性显示细胞学阳性样本。PJC阳性/阴性且随访时间<4年的患者被排除为未确诊病例。非恶性诊断基于组织病理学缺失/稳定的影像学表现≥4年。主要终点是证明ERP/ENPD-PJC比ERP-PJC具有更高的诊断能力。
结果:纳入22例经组织病理学诊断为PDAC/HG-PanIN的患者和31例非恶性诊断的患者。ERP-PJC,ERP/ENPD-PJC,ENPD-PJC的敏感性为36.4%,86.4%,和77.3%,93.5%的特异性,87.1%,93.5%,准确率为69.8%,86.7%,和86.7%,分别。与ERP-PJC相比,ERP/ENPD-PJC和ENPD-PJC表现出更高的灵敏度和准确性。阳性结果的更多出现显着区分真阳性和假阳性。
结论:ERP/ENPD-PJC和ENPD-PJC对PDAC/HG-PanIN的诊断准确性更高,在EUS上无可见肿瘤。建议将ENPD-PJC用于这些病变的诊断。
OBJECTIVE: Pancreatic ductal adenocarcinoma (PDAC) with a diameter ≤10 mm and high-grade pancreatic intraepithelial neoplasia (HG-PanIN) require pre-operative diagnosis. Most cases present only indirect imaging findings without visible tumors on endoscopic ultrasound (EUS). Therefore, EUS-guided fine-needle aspiration/biopsy is not applicable. An alternative diagnostic method is pancreatic juice cytology (PJC) via endoscopic naso-pancreatic drainage (ENPD-PJC), which is not the standard practice. This study aimed to investigate ENPD-PJC for diagnosing suspected PDAC/HG-PanIN cases without visible tumors on EUS.
METHODS: Data of patients with suspected PDAC/HG-PanIN without visible tumors who underwent PJC were retrospectively evaluated. One PJC sample was collected during endoscopic retrograde pancreatography (ERP-PJC), and 12 samples were collected during ENPD-PJC, 3-hourly for cytological analysis. ERP-PJC, ERP/ENPD-PJC, and ENPD-PJC positivity indicated cytologically positive samples. Patients with positive/negative PJC with follow-up for <4-years were excluded as undiagnosed cases. A non-malignant diagnosis was based on histopathological absence/stable imaging findings for ≥4-years. The primary endpoint was to demonstrate that ERP/ENPD-PJC has a higher diagnostic ability than ERP-PJC.
RESULTS: Twenty-two patients with histopathologically diagnosed PDAC/HG-PanIN and 31 with a non-malignant diagnosis were enrolled. ERP-PJC, ERP/ENPD-PJC, and ENPD-PJC showed sensitivities of 36.4 %, 86.4 %, and 77.3 %, specificities of 93.5 %, 87.1 %, and 93.5 %, and accuracies of 69.8 %, 86.7 %, and 86.7 %, respectively. ERP/ENPD-PJC and ENPD-PJC demonstrated superior sensitivity and accuracy compared to ERP-PJC. A greater occurrence of positive outcomes markedly distinguished true positives from false positives.
CONCLUSIONS: ERP/ENPD-PJC and ENPD-PJC had higher diagnostic accuracies for PDAC/HG-PanIN without visible tumors on EUS. ENPD-PJC is recommended for the diagnosis of these lesions.