title: Role of pancreatic juice cytology in the preoperative management of intraductal papillary mucinous neoplasm of the pancreas in the era of international consensus guidelines 2012.
abstract: BACKGROUND
  Routine endoscopic retrograde pancreatography (ERP) for pancreatic juice cytology (PJC) during management of intraductal papillary mucinous neoplasm (IPMN) is not recommended in the international consensus guidelines 2012. The aim of the present study was to investigate the roles of PJC in relation to the new stratification of clinical findings in the consensus guidelines 2012.
  
  
  METHODS
  Medical records of 70 consecutive patients who underwent preoperative PJC, subsequent pancreatectomy, and a pathological diagnosis of IPMN were reviewed. Diagnostic ability of PJC to detect malignant lesions was calculated by the stratification of clinical findings.
  
  
  RESULTS
  Forty patients had malignant lesions, including 29 with malignant IPMN, 10 with concomitant pancreatic adenocarcinoma, and one with both. Accuracies of PJC in all 70 patients and in 59 patients with IPMN alone were 77 and 80 %, respectively. The sensitivity and accuracy of PJC in patients with "worrisome features" were 100 and 94 %, respectively. Eight of 11 patients with concomitant pancreatic adenocarcinoma had non-malignant IPMN without risk factors, and 3 significant lesions could be diagnosed only by ERP/PJC. In addition, the management plan based on imaging study changed from observation to resection in two patients who had the single "worrisome feature" of branch duct IPMN and positive PJC results. As a result, PJC altered the management plan in 5 patients.
  
  
  CONCLUSIONS
  Pancreatic juice cytology potentially has important roles to determine the adequate treatment choice in patients with IPMNs with "worrisome features," and to detect significant lesions that could not be detected by other imaging modalities.
authors.affiliation: Departments of Surgery and Oncology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan, takao-o@surg1.med.kyushu-u.ac.jp.
authors.forename: Takao
authors.initials: T
authors.lastname: Ohtsuka
authors.forename: Taketo
authors.initials: T
authors.lastname: Matsunaga
authors.forename: Hideyo
authors.initials: H
authors.lastname: Kimura
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Koji
authors.initials: K
authors.lastname: Tamura
authors.forename: Noboru
authors.initials: N
authors.lastname: Ideno
authors.forename: Teppei
authors.initials: T
authors.lastname: Aso
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Miyasaka
authors.forename: Junji
authors.initials: J
authors.lastname: Ueda
authors.forename: Shunichi
authors.initials: S
authors.lastname: Takahata
authors.forename: Takashi
authors.initials: T
authors.lastname: Osoegawa
authors.forename: Hisato
authors.initials: H
authors.lastname: Igarashi
authors.forename: Tetsuhide
authors.initials: T
authors.lastname: Ito
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ushijima
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Ookubo
authors.forename: Yoshinao
authors.initials: Y
authors.lastname: Oda
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Mizumoto
authors.forename: Masao
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D003581:Cytodiagnosis; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010189:Pancreatic Juice / Q000166:cytology*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000628:therapy; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D014056:Tomography, X-Ray; D057832:Watchful Waiting