title: Diagnosis of pancreatic cancer by cytology and measurement of oncogene and tumor markers in pure pancreatic juice aspirated by endoscopy.
abstract: OBJECTIVE
  Cytological examination of pancreatic juice is useful in the diagnosis of an occult cancer of the pancreas. The early diagnosis of pancreatic carcinoma using traditional radiographic or ultrasonographic methods is extremely difficult.
  
  
  METHODS
  In order to detect an early pancreatic cancer, cytological examination, measurement of tumor marker, and detection of K-ras point mutation were performed using the samples of pure pancreatic juice aspirated endoscopically in patients who had symptoms or findings that suggested pancreatic disease.
  
  
  RESULTS
  By routine ERP-cytology, positive cytologic results were obtained in 15 (4%) out of 359 patients without a mass. With the aid of intra-operative cytodiagnosis, all 15 occult neoplasms of the pancreas were successfully resected. One patient died from another disease without evidence of recurrence. However, the other patients were alive with no evidence of recurrence for an average of 5.5 years following surgery. The patients who had negative ERP-cytology results were observed, but no further cases of pancreatic cancer were found. The CEA levels in the pure pancreatic juice were significantly higher in patients with pancreatic cancer than in those with pancreatitis. K-ras point mutation at codon 12 was detected not only in cases of pancreatic cancer, but also in cases of chronic pancreatitis as well as control subjects.
  
  
  CONCLUSIONS
  Cytological examination of pancreatic juice is useful in the diagnosis of an early and potentially curable in situ cancer of the pancreas. The CEA levels in the pure pancreatic juice provided useful information for differentiating the pancreatic cancer from chronic pancreatitis. K-ras point mutation at codon 12 in pancreatic juice was considered to be useful in identifying patients at high risk for the development of pancreatic cancer.
authors.affiliation: Department of Gastroenterology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Nakaizumi
authors.forename: H
authors.initials: H
authors.lastname: Uehara
authors.forename: A
authors.initials: A
authors.lastname: Takenaka
authors.forename: N
authors.initials: N
authors.lastname: Uedo
authors.forename: N
authors.initials: N
authors.lastname: Sakai
authors.forename: H
authors.initials: H
authors.lastname: Yano
authors.forename: H
authors.initials: H
authors.lastname: Ohigashi
authors.forename: O
authors.initials: O
authors.lastname: Ishikawa
authors.forename: S
authors.initials: S
authors.lastname: Ishiguro
authors.forename: K
authors.initials: K
authors.lastname: Sugano
authors.forename: M
authors.initials: M
authors.lastname: Tatsuta
mesh_terms: D000368:Aged; D018395:CA-19-9 Antigen / Q000032:analysis; D002272:Carcinoembryonic Antigen / Q000032:analysis; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D011905:Genes, ras; D006801:Humans; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis* / Q000235:genetics; D010189:Pancreatic Juice / Q000737:chemistry* / Q000166:cytology*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000235:genetics; D017354:Point Mutation; D011446:Prospective Studies
chemical_list: D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen