title: Utility of pancreatic duct brushing for diagnosis of pancreatic carcinoma.
abstract: BACKGROUND
  The aim of this study was to evaluate the usefulness of pancreatic duct brushing for diagnosis of pancreatic carcinoma.
  
  
  METHODS
  Brush cytology was attempted in 58 patients suspected of having pancreatic malignancy because of stricture of the main pancreatic duct, confirmed by endoscopic retrograde cholangiopancreatography. Thirty-eight patients were finally diagnosed by an operation or the clinical course as having pancreatic carcinoma, and the remaining 20 patients as having chronic pancreatitis. The usefulness of brush cytology for diagnosis of pancreatic carcinoma was estimated. We interpreted failures of pancreatic duct brushing to be false negatives when the lesion was malignant.
  
  
  RESULTS
  In 48 of 58 patients (82.8%), brushing was successfully performed and satisfactory specimens were obtained. Brush cytology was positive in 25 of 38 patients with pancreatic carcinoma (sensitivity 65.8%) and negative in all patients without malignancy (specificity 100%). Overall accuracy was 76.4%. During 2001-2005, the number of back-and-forth motions of the brush was increased to more than 30 times. The sensitivity significantly improved from 43.8% in 1997-2000 to 81.8% in 2001-2005 (P < 0.05). The increased success rate of brushing by improvement of skill in manipulating the guidewire and increased number of cells smeared on glass slides by increased back-and-forth motion of the brush may account for this improvement over time. Moreover, the sensitivity in 2001-2005 was 85.7% if failures of brushing with pancreatic carcinoma are excluded. No major complications occurred, except for two patients with a moderate grade of acute pancreatitis.
  
  
  CONCLUSIONS
  Although further studies with a large number of patients are needed, our results suggest that with recent improvements of the brushing technique, pancreatic duct brushing is a useful and safe method for the differential diagnosis of malignancy from benign diseases of the pancreas.
authors: Department of Gastroenterology and Neurology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun 761-0793, Japan.
authors: Naohito
authors: N
authors: Uchida
authors: Hideki
authors: H
authors: Kamada
authors: Kunihiko
authors: K
authors: Tsutsui
authors: Masahiro
authors: M
authors: Ono
authors: Yuichi
authors: Y
authors: Aritomo
authors: Tsutomu
authors: T
authors: Masaki
authors: Yoshio
authors: Y
authors: Kushida
authors: Reiji
authors: R
authors: Haba
authors: Toshiaki
authors: T
authors: Nakatsu
authors: Shigeki
authors: S
authors: Kuriyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods / Q000706:statistics & numerical data*; D002277:Carcinoma / Q000473:pathology*; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010183:Pancreatic Ducts / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000473:pathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies
references: Gastrointest Endosc. 2002 Dec;56(6):864-7
references: 12447299
references: Am J Gastroenterol. 2002 Jun;97(6):1386-91
references: 12094855
references: J Gastrointest Surg. 2003 Jan;7(1):118-26; discussion 127-8
references: 12559193
references: Ann Intern Med. 2001 Mar 20;134(6):459-64
references: 11255521
references: Am J Gastroenterol. 2004 May;99(5):844-50
references: 15128348
references: Gastrointest Endosc. 2004 Aug;60(2):267-79
references: 15278063
references: Cancer. 1996 Jun 1;77(11):2233-9
references: 8635089
references: Gastrointest Endosc. 1998 May;47(5):335-40
references: 9609423
references: Gastrointest Endosc. 1991 May-Jun;37(3):383-93
references: 2070995
references: Gastrointest Endosc. 2001 Nov;54(5):595-9
references: 11677475
references: Am J Gastroenterol. 2003 Dec;98(12):2663-8
references: 14687813
references: Gastrointest Endosc. 1999 Mar;49(3 Pt 1):322-7
references: 10049415
references: Gastrointest Endosc. 2001 Apr;53(4):470-4
references: 11275888
references: Gastrointest Endosc. 1994 Mar-Apr;40(2 Pt 1):140-5
references: 8013810
references: Gastrointest Endosc. 1997 Mar;45(3):243-50
references: 9087830
references: Gastrointest Endosc. 1996 Sep;44(3):300-4
references: 8885350
references: Acta Cytol. 1995 Jan-Feb;39(1):11-8
references: 7846997
references: Arch Pathol Lab Med. 2000 Mar;124(3):387-92
references: 10705391