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01-11-2014

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

Authors: Takao Ohtsuka, 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

Published in: World Journal of Surgery | Issue 11/2014

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.

Tanaka M, Chari ST, Adsay V et al (2006) International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 6:17–32PubMedCrossRef

Tanaka M, Fernández-del Castillo C, Adsay V et al (2012) International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 12:183–197PubMedCrossRef

Ohno E, Hirooka Y, Itoh A et al (2009) Intraductal papillary mucinous neoplasms of the pancreas: differentiation of malignant and benign tumors by endoscopic ultrasonography findings of mural nodules. Ann Surg 249:628–634PubMedCrossRef

Ohtsuka T, Kono H, Nagayoshi Y et al (2012) An increase in the number of predictive factors augments the likelihood of malignancy in branch duct intraductal papillary mucinous neoplasm of the pancreas. Surgery 151:76–83PubMedCrossRef

Shimizu Y, Yamaue H, Maguchi H et al (2013) Predictors of malignancy in intraductal papillary mucinous neoplasm of the pancreas: analysis of 310 pancreatic resection patients at multiple high-volume centers. Pancreas 42:883–888PubMedCrossRef

Poultsides GA, Reddy S, Cameron JL et al (2010) Histopathologic basis for the favorable survival after resection of intraductal papillary mucinous neoplasm-associated invasive adenocarcinoma of the pancreas. Ann Surg 251:470–476PubMedCrossRefPubMedCentral

Furukawa T, Hatori T, Fujita I et al (2011) Prognostic relevance of morphological types of intraductal papillary mucinous neoplasms of the pancreas. Gut 60:509–516PubMedCrossRef

Mino-Kenudson M, Fernández-del Castillo C, Baba Y et al (2011) Prognosis of invasive intraductal papillary mucinous neoplasm depends on histological and precursor epithelial subtypes. Gut 60:1712–1720PubMedCrossRefPubMedCentral

Rodriguez JR, Salvia R, Crippa S et al (2007) Branch-duct intraductal papillary mucinous neoplasms: observations in 145 patients who underwent resection. Gastroenterology 133:72–79PubMedCrossRefPubMedCentral

10.

Maguchi H, Tanno S, Mizuno N et al (2011) Natural history of branch duct intraductal papillary mucinous neoplasms of the pancreas: a multicenter study in Japan. Pancreas 40:364–370PubMedCrossRef

11.

Ohtsuka T, Kono H, Tanabe R et al (2012) Follow-up study after resection of intraductal papillary mucinous neoplasm of the pancreas; special references to the multifocal lesions and development of ductal carcinoma in the remnant pancreas. Am J Surg 204:44–48PubMedCrossRef

12.

Yamaguchi K, Nakamura M, Shirahane K et al (2005) Pancreatic juice cytology in IPMN of the pancreas. Pancreatology 5:416–421PubMedCrossRef

13.

Yamaguchi T, Shirai Y, Ishihara T et al (2005) Pancreatic juice cytology in the diagnosis of intraductal papillary mucinous neoplasm of the pancreas. Significance of sampling by peroral pancreatoscopy. Cancer 104:2830–2836PubMedCrossRef

14.

Hibi Y, Fukushima N, Tsuchida A et al (2007) Pancreatic juice cytology and subclassification of intraductal papillary mucinous neoplasms of the pancreas. Pancreas 34:197–204PubMedCrossRef

15.

Tanaka M, Yokohata K, Konomi H et al (1997) Segmental balloon cytology for preoperative localization of in situ pancreatic cancer. Gastrointest Endosc 46:447–449PubMedCrossRef

16.

Yamaguchi K, Nakamura K, Yokohata K et al (1997) Pancreatic cyst as a sentinel of in situ carcinoma of the pancreas. Report of two cases. Int J Pancreatol 22:227–231PubMed

17.

Ohtsuka T, Ideno N, Aso T et al (2013) Role of endoscopic retrograde pancreatography for early detection of pancreatic ductal adenocarcinoma concomitant with intraductal papillary mucinous neoplasm of the pancreas. J Hepatobiliary Pancreat Sci 20:356–361PubMedCrossRef

18.

Shindo K, Ueda J, Aishima S et al (2013) Small-sized, flat-type invasive branch duct intraductal papillary mucinous neoplasm: a case report. Case Rep Gastroenterol 7:449–454PubMedCrossRefPubMedCentral

19.

Adsay V, Kloppel G, Fukushima N et al (2010) Intraductal papillary-mucinous neoplasms of the pancreas. In: Bosman FT, Carneiro F, Hruban RH et al (eds) World Health Organization classification of tumors, pathology and genetics of tumors of the digestive system. IARC Press, Lyon, pp 304–313

20.

Ideno N, Ohtsuka T, Tamura K et al (2013) Intraductal papillary mucinous neoplasms of the pancreas with distinct pancreatic ductal adenocarcinomas are frequently of gastric subtype. Ann Surg 258:141–151PubMedCrossRef

21.

Japan Pancreas Society (2011) Classification of pancreatic carcinoma (3rd english edition). Kanehara Press, Tokyo

22.

Chari ST, Yadav D, Smyrk TC et al (2002) Study of recurrence after surgical resection of intraductal papillary mucinous neoplasm of the pancreas. Gastroenterology 123:1500–1507PubMedCrossRef

23.

Salvia R, Fernández-del Castillo C, Bassi C et al (2004) Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg 239:678–685PubMedCrossRefPubMedCentral

24.

Tamura K, Ohtsuka T, Ideno N et al (2014) Treatment strategy for main-duct intraductal papillary mucinous neoplasms of the pancreas based on the assessment of the recurrences in the remnant pancreas after resection: a retrospective review. Ann Surg 259:360–368PubMedCrossRef

25.

Hirono S, Tani M, Kawai M et al (2012) The carcinoembryonic antigen level in pancreatic juice and mural nodule size are predictors of malignancy of branch duct type intraductal papillary mucinous neoplasms of the pancreas. Ann Surg 255:517–522PubMedCrossRef

26.

Shimamoto T, Tani M, Kawai M et al (2010) MUC1 is a useful molecular marker for malignant intraductal papillary mucinous neoplasms in pancreatic juice obtained from endoscopic retrograde pancreatography. Pancreas 39:879–883PubMedCrossRef

27.

Inoue H, Tsuchida A, Kawasaki Y et al (2001) Preoperative diagnosis of intraductal papillary-mucinous tumors of the pancreas with attention to telomerase activity. Cancer 91:35–41PubMedCrossRef

28.

Uehara H, Nakaizumi A, Ishikawa O et al (2008) Development of ductal carcinoma of the pancreas during follow-up of branch duct intraductal papillary mucinous neoplasm of the pancreas. Gut 57:1561–1565PubMedCrossRef

29.

Tanno S, Nakano Y, Sugiyama Y et al (2010) Incidence of synchronous and metachronous pancreatic carcinoma in 168 patients with branch duct intraductal papillary mucinous neoplasms. Pancreatology 10:173–178PubMedCrossRef

30.

Ingkakul T, Sadakari Y, Ienaga J et al (2010) Predictors of the presence of concomitant invasive ductal carcinoma in intraductal papillary mucinous neoplasm of the pancreas. Ann Surg 251:70–75PubMedCrossRef

31.

Yamaguchi K, Kanemitsu S, Hatori T et al (2011) Pancreatic ductal adenocarcinoma derived from IPMN and pancreatic ductal adenocarcinoma concomitant with IPMN. Pancreas 40:571–580PubMedCrossRef

32.

Kanda M, Knight S, Topazian M et al (2013) Mutant GNAS detected in duodenal collections of secretin-stimulated pancreatic juice indicates the presence or emergence of pancreatic cysts. Gut 62:719–730CrossRef

33.

Kamata K, Kitano M, Kudo M et al (2014) Value of EUS in early detection of pancreatic ductal adenocarcinomas in patients with intraductal papillary mucinous neoplasms. Endoscopy 46:22–29PubMedCrossRef

34.

Barron MR, Roch AM, Waters JA et al (2014) Does preoperative cross-sectional imaging accurately predict main duct involvement in intraductal papillary mucinous neoplasm? J Gastrointest Surg 18:447–456PubMedCrossRef

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
Authors: Takao Ohtsuka
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
Publication date: 01-11-2014
Publisher: Springer US
Published in: World Journal of Surgery / Issue 11/2014
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-014-2684-y

Keynote webinar | Spotlight on medication adherence

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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

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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