title: Pancreatic-duct-lavage cytology in candidates for surgical resection of branch-duct intraductal papillary mucinous neoplasm of the pancreas: should the International Consensus Guidelines be revised?
abstract: BACKGROUND
  The International Consensus Guidelines are helpful for the management of branch-duct intraductal papillary mucinous neoplasms (IPMNs), because they allow us to exclude malignancy. However, it is not possible to predict malignancy with certainty, and further preoperative differentiation between benign and malignant IPMNs is required to avoid the false-positive results.
  
  
  OBJECTIVE
  To examine the usefulness of pancreatic-duct-lavage cytology by using an originally designed double-lumen catheter for discriminating benign and malignant IPMNs of the branch-duct type in candidates for surgical resection based on the International Consensus Guidelines.
  
  
  METHODS
  Pancreatic-duct-lavage cytology was investigated in 24 patients with branch-duct IPMNs who underwent surgical resection based on the International Consensus Guidelines, namely, they either had intramural nodules or the ectatic branch duct was >30 mm in diameter.
  
  
  METHODS
  Single-center retrospective study.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  The sensitivity and specificity of pancreatic-duct-lavage cytology for discriminating benign from malignant IPMNs.
  
  
  RESULTS
  More than 30 mL of pancreatic-duct-lavage fluid was obtained from each patient, and there were no patients with noninformative results. The sensitivity, specificity, positive predictive value, and negative predictive value of the cytologic diagnosis were 78%, 93%, 88%, and 88%, respectively.
  
  
  CONCLUSIONS
  Single-center and small number of patients.
  
  
  CONCLUSIONS
  Pancreatic-duct-lavage cytology can improve differentiation between benign and malignant IPMNs of the branch-duct type in candidates for surgical resection based on the International Consensus Guidelines.
authors.affiliation: Department of Gastroenterology, Juntendo University, Tokyo, Japan. jinkans@med.juntendo.ac.jp
authors.forename: Jin Kan
authors.initials: JK
authors.lastname: Sai
authors.forename: Masafumi
authors.initials: M
authors.lastname: Suyama
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kubokawa
authors.forename: Sumio
authors.initials: S
authors.lastname: Watanabe
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Maehara
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000473:pathology*; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D007507:Therapeutic Irrigation