Optimal indication of adding pancreatic juice cytology in the diagnosis of malignant intraductal papillary mucinous neoplasm of the pancreas

Takeshi Mori; Yasutaka Ishii; Yumiko Tatsukawa; Shinya Nakamura; Juri Ikemoto; Sayaka Miyamoto; Kazuki Nakamura; Masaru Furukawa; Yumiko Yamashita; Noriaki Iijima; Yasuhiro Okuda; Risa Nomura; Koji Arihiro; Kenichiro Uemura; Shinya Takahashi; Hideki Ohdan; Shiro Oka

doi:10.1016/j.pan.2024.12.010

Optimal indication of adding pancreatic juice cytology in the diagnosis of malignant intraductal papillary mucinous neoplasm of the pancreas

Pancreatology. 2024 Dec 19:S1424-3903(24)00838-X. doi: 10.1016/j.pan.2024.12.010. Online ahead of print.

Authors

Takeshi Mori¹, Yasutaka Ishii², Yumiko Tatsukawa¹, Shinya Nakamura¹, Juri Ikemoto¹, Sayaka Miyamoto¹, Kazuki Nakamura¹, Masaru Furukawa¹, Yumiko Yamashita¹, Noriaki Iijima¹, Yasuhiro Okuda¹, Risa Nomura¹, Koji Arihiro³, Kenichiro Uemura⁴, Shinya Takahashi⁴, Hideki Ohdan⁵, Shiro Oka¹

Affiliations

¹ Department of Gastroenterology, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
² Department of Gastroenterology, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan. Electronic address: yishii@hiroshima-u.ac.jp.
³ Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan.
⁴ Department of Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
⁵ Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.

PMID: 39730218
DOI: 10.1016/j.pan.2024.12.010

Abstract

Background/objectives: Positive pancreatic juice cytology (PJC) is an important finding when considering surgical resection in patients with intraductal papillary mucinous neoplasm (IPMN); however, guidelines do not recommend endoscopic retrograde cholangiopancreatography (ERCP) for PJC. This study aimed to clarify the findings worthy of adding PJC for diagnosing high-grade dysplasia (HGD) and invasive carcinoma (IC) in patients with IPMN.

Methods: Patients with IPMN who underwent preoperative PJC and surgical resection at Hiroshima University Hospital were enrolled, and the diagnostic yield of malignant IPMN based on PJC and clinical and imaging findings and the incidence of post-ERCP pancreatitis (PEP) were retrospectively analyzed.

Results: Of the 129 eligible patients, 61 (47%) had malignant tumors (29 HGD and 32 IC). The diagnostic yields of PJC were as follows: 33%, 97%, 91%, 62%, and 67% for sensitivity, specificity, and positive predictive value, and negative predictive value, respectively. Multivariate analysis revealed that an abrupt change in the pancreatic duct caliber was an independent predictive factor of true-positive PJC (hazard ratio: 15.81, P = 0.001), with a diagnostic sensitivity of 86% for PJC in these patients. The incidence rate of PEP was 19%, and the pancreatic body and tail lesions, main pancreatic duct diameter <10 mm, and placement of a nasopancreatic drainage catheter were significant risk factors for PEP.

Conclusions: Although PJC is generally not recommended for patients with IPMN, it is worth considering for the determination of treatment strategies in patients with abrupt changes in the caliber of the pancreatic duct with distal pancreatic atrophy.

Keywords: High-risk stigmata; Intraductal papillary mucinous neoplasm; Pancreatic juice cytology; Pancreatitis; Worrisome features.