title: Value of cytodiagnosis using endoscopic nasopancreatic drainage for early diagnosis of pancreatic cancer: establishing a new method for the early detection of pancreatic carcinoma in situ.
abstract: OBJECTIVE
  We examined the results of pancreatic juice cytodiagnosis using the method of endoscopic nasopancreatic drainage (ENPD) to identify pancreatic carcinoma in situ and compared the images and pathologic diagnosis of pancreatic carcinoma in situ as well as clinicopathologic characteristics.
  
  
  METHODS
  In patients who underwent endoscopic retrograde cholangiopancreatography and had ENPD place, only patients presenting with focal stenosis and distal dilatation of the main pancreatic duct were included in the ENPD placement group. Endoscopic nasopancreatic drainage was conducted 27 times in 20 patients in the ENPD placement group. In an average session, cytodiagnosis of the pancreatic juice was conducted 5.3 times (range, 2-11 times).
  
  
  RESULTS
  Results of cytodiagnosis were positive in 15 of 20 patients. Results of ENPD cytodiagnosis and diagnosis of pancreatic cancer showed sensitivity of 100%, specificity of 83.3%, and accuracy of 95%. Seven of 15 patients were diagnosed with carcinoma in situ. In these 7 patients, tumor markers (carcinoembryonic antigen, CA-19-9) were within reference limits, and the tumors were not visible on imaging tests. Pathologic histology revealed a propensity for the cancer to proliferate around the stenosis of the pancreatic duct.
  
  
  CONCLUSIONS
  Cytodiagnosis of pancreatic juice using ENPD multiple times proved to be useful in the diagnosis of pancreatic carcinoma in situ.
authors.affiliation: Department of Gastroenterology, JA Onomichi General Hospital, Onomichi, Japan. e-boshi@hotmail.co.jp
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Iiboshi
authors.forename: Keiji
authors.initials: K
authors.lastname: Hanada
authors.forename: Toshikatsu
authors.initials: T
authors.lastname: Fukuda
authors.forename: Shuji
authors.initials: S
authors.lastname: Yonehara
authors.forename: Tamito
authors.initials: T
authors.lastname: Sasaki
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000175:diagnosis*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003581:Cytodiagnosis / Q000379:methods; D004322:Drainage / Q000379:methods*; D055088:Early Detection of Cancer / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010189:Pancreatic Juice / Q000166:cytology*; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity