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

Ohtsuka Takao, Taketo Matsunaga, Hideyo Kimura, Yusuke Watanabe, Koji Tamura, Noboru Ideno, Teppei Aso, Yoshihiro Miyasaka, Junji Ueda, Shunichi Takahata, Takashi Osoegawa, Hisato Igarashi, Tetsuhide Ito, yasuhiro ushijima, Fumihiko Ookubo, Yoshinao Oda, Kazuhiro Mizumoto, Masao Tanaka

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)2994-3001
Number of pages8
JournalWorld journal of surgery
Volume38
Issue number11
DOIs
Publication statusPublished - Nov 1 2014

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Pancreatic Juice
Pancreatic Neoplasms
Cell Biology
Guidelines
Neoplasms
Adenocarcinoma
Pancreatectomy
Medical Records
Observation

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

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. / Takao, Ohtsuka; Matsunaga, Taketo; Kimura, Hideyo; Watanabe, Yusuke; Tamura, Koji; Ideno, Noboru; Aso, Teppei; Miyasaka, Yoshihiro; Ueda, Junji; Takahata, Shunichi; Osoegawa, Takashi; Igarashi, Hisato; Ito, Tetsuhide; ushijima, yasuhiro; Ookubo, Fumihiko; Oda, Yoshinao; Mizumoto, Kazuhiro; Tanaka, Masao.

In: World journal of surgery, Vol. 38, No. 11, 01.11.2014, p. 2994-3001.

Research output: Contribution to journalArticle

Takao, O, Matsunaga, T, Kimura, H, Watanabe, Y, Tamura, K, Ideno, N, Aso, T, Miyasaka, Y, Ueda, J, Takahata, S, Osoegawa, T, Igarashi, H, Ito, T, ushijima, Y, Ookubo, F, Oda, Y, Mizumoto, K & Tanaka, M 2014, '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', World journal of surgery, vol. 38, no. 11, pp. 2994-3001. https://doi.org/10.1007/s00268-014-2684-y
Takao, Ohtsuka ; Matsunaga, Taketo ; Kimura, Hideyo ; Watanabe, Yusuke ; Tamura, Koji ; Ideno, Noboru ; Aso, Teppei ; Miyasaka, Yoshihiro ; Ueda, Junji ; Takahata, Shunichi ; Osoegawa, Takashi ; Igarashi, Hisato ; Ito, Tetsuhide ; ushijima, yasuhiro ; Ookubo, Fumihiko ; Oda, Yoshinao ; Mizumoto, Kazuhiro ; Tanaka, Masao. / 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. In: World journal of surgery. 2014 ; Vol. 38, No. 11. pp. 2994-3001.
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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.",
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T1 - 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

AU - Takao, Ohtsuka

AU - Matsunaga, Taketo

AU - Kimura, Hideyo

AU - Watanabe, Yusuke

AU - Tamura, Koji

AU - Ideno, Noboru

AU - Aso, Teppei

AU - Miyasaka, Yoshihiro

AU - Ueda, Junji

AU - Takahata, Shunichi

AU - Osoegawa, Takashi

AU - Igarashi, Hisato

AU - Ito, Tetsuhide

AU - ushijima, yasuhiro

AU - Ookubo, Fumihiko

AU - Oda, Yoshinao

AU - Mizumoto, Kazuhiro

AU - Tanaka, Masao

PY - 2014/11/1

Y1 - 2014/11/1

N2 - 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.

AB - 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.

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U2 - 10.1007/s00268-014-2684-y

DO - 10.1007/s00268-014-2684-y

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JO - World Journal of Surgery

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