Pancreatic intraductal sampling during ERCP in patients with chronic pancreatitis and pancreatic cancer: cytologic studies and k-ras-2 codon 12 molecular analysis in 47 cases.
BACKGROUND
A preoperative tissue diagnosis of pancreatic cancer is desirable but difficult to obtain.


METHODS
Pancreatic brush cytology, salvage cytology, and collection of pancreatic juice were attempted prospectively during ERCP in 34 patients with pancreatic cancer and 11 with chronic pancreatitis. K-ras-2 codon 12 was analyzed for presence and type of point mutations.


RESULTS
Brush cytology coupled with salvage cytology had a sensitivity of 74%. The addition of cytologic analysis of pancreatic juice did not substantially improve sensitivity (76%). K-ras-2 was mutated in both cancer (87%) and pancreatitis (40%). The specificity for cytology was 100% and for K-ras-2 mutations 60%. Combining cytology with mutation analysis increased sensitivity to 93% but reduced the positive predictive value. The negative predictive value never exceeded 75%. None of the patients with chronic pancreatitis had cancer develop (median follow-up 60 months).


CONCLUSIONS
Pancreatic ductal brushing with salvage cytology is useful in the diagnosis of cancer, whereas cytologic analysis of pancreatic juice can be abandoned. At present, K-ras-2 mutation is not useful for differentiating pancreatic cancer from chronic pancreatitis or the identification of patients with chronic pancreatitis at risk for malignant transformation.
Pugliese
V
V
Center for Gastrointestinal Endoscopy, the Department of Oncology, University of Genoa, Italy.
Pujic
N
N
Saccomanno
S
S
Gatteschi
B
B
Pera
C
C
Aste
H
H
Ferrara
G B
GB
Nicolò
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002908:Chronic Disease; D003062:Codon; D003581:Cytodiagnosis / Q000295:instrumentation / Q000379:methods; D004252:DNA Mutational Analysis; D005260:Female; D011905:Genes, ras; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D010183:Pancreatic Ducts / Q000473:pathology; D010189:Pancreatic Juice / Q000166:cytology; D010190:Pancreatic Neoplasms / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D010195:Pancreatitis / Q000235:genetics* / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity
D003062:Codon