title: Usefulness of brush cytology combined with pancreatic juice cytology in the diagnosis of pancreatic cancer: significance of pancreatic juice cytology after brushing.
abstract: OBJECTIVE
  Pancreatic juice cytology (PJC) and brush cytology (BC) performed during endoscopic retrograde cholangiopancreatography could make a definite diagnosis of pancreatic cancer. The aim of this study was to improve the diagnostic value of cytology performed during endoscopic retrograde cholangiopancreatography in the diagnosis of pancreatic cancer.
  
  
  METHODS
  The subjects comprised 127 patients with pancreatic ductal adenocarcinoma (PDAC) and 74 with benign pancreatic duct stricture mimicking PDAC. Final diagnosis was confirmed based on histopathology by resection or on more than 1 year of follow up. Pancreatic juice cytology was examined before and after BC. And the sensitivity of PJC combined with BC was examined.
  
  
  RESULTS
  No malignancy was detected by PJC or by BC in patients with benign pancreatic duct strictures (specificity, 100%). In those with PDAC, the sensitivity of PJC before and after brushing was 21.3% and 40.9%, respectively; that of BC was 48.8%. Of 65 patients with PDAC, in whom neither PJC before brushing nor BC indicated malignancy, 16 were diagnosed with pancreatic cancer using PJC after brushing. Brush cytology combined with PJC after brushing significantly raised the diagnostic sensitivity for PDAC to 61.4%.
  
  
  CONCLUSIONS
  Diagnosis of pancreatic cancer based on BC combined with PJC after brushing was more reliable than PJC before brushing or BC.
authors.affiliation: Department of Gastroenterology, Chiba Cancer Center, Funabashi Municipal Hospital, Chiba, Japan. tyamaguchi@chiba-cc.jp
authors.forename: Taketo
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Shirai
authors.forename: Nami
authors.initials: N
authors.lastname: Nakamura
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sudo
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Nakamura
authors.forename: Shuichi
authors.initials: S
authors.lastname: Hironaka
authors.forename: Taro
authors.initials: T
authors.lastname: Hara
authors.forename: Tadamichi
authors.initials: T
authors.lastname: Denda
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000473:pathology; D003581:Cytodiagnosis / Q000379:methods; D003584:Cytological Techniques / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000473:pathology; D010189:Pancreatic Juice / Q000166:cytology*; D010190:Pancreatic Neoplasms / Q000473:pathology*; D012680:Sensitivity and Specificity