Repeated pancreatic juice cytology via endoscopic nasopancreatic drainage catheter combined with clinical findings improves diagnostic ability for malignant cases of suspected pancreatic cancer with non-identifiable tumors

Tatsunori Satoh; Junichi Kaneko; Eiji Nakatani; Hirotoshi Ishiwatari; Junya Sato; Akihiko Ohata; Reiko Yamada; Tetsuro Miwata; Kazuma Ishikawa; Fumitaka Niiya; Yosuke Kobayashi; Yasushi Hamaya; Jun Ito; Kazuhito Kawata; Azumi Suzuki; Yasunari Sakamoto; Yuya Ishiguro; Haruna Takahashi; Shinya Kawaguchi

doi:10.1016/j.pan.2024.11.022

Repeated pancreatic juice cytology via endoscopic nasopancreatic drainage catheter combined with clinical findings improves diagnostic ability for malignant cases of suspected pancreatic cancer with non-identifiable tumors

Pancreatology. 2024 Nov 29:S1424-3903(24)00807-X. doi: 10.1016/j.pan.2024.11.022. Online ahead of print.

Authors

Tatsunori Satoh¹, Junichi Kaneko², Eiji Nakatani³, Hirotoshi Ishiwatari⁴, Junya Sato⁴, Akihiko Ohata⁵, Reiko Yamada⁶, Tetsuro Miwata⁶, Kazuma Ishikawa⁷, Fumitaka Niiya⁸, Yosuke Kobayashi⁹, Yasushi Hamaya¹⁰, Jun Ito¹¹, Kazuhito Kawata¹¹, Azumi Suzuki¹², Yasunari Sakamoto¹³, Yuya Ishiguro¹⁴, Haruna Takahashi¹⁵, Shinya Kawaguchi¹⁵

Affiliations

¹ Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan. Electronic address: tatsunori-sato@i.shizuoka-pho.jp.
² Department of Gastroenterology, Iwata City Hospital, Shizuoka, Japan.
³ Department of Biostatistics and Health Data Science, Graduate School of Medical Science Nagoya City University, Nagoya, Japan.
⁴ Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.
⁵ Department of Gastroenterology, Fujieda Municipal General Hospital, Shizuoka, Japan.
⁶ Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Mie, Japan.
⁷ Department of Medical Oncology, School of Medicine, Sapporo Medical University, Hokkaido, Japan.
⁸ Division of Gastroenterology, Showa University Fujigaoka Hospital, Kanagawa, Japan.
⁹ Department of Gastroenterology, Seirei Hamamatsu General Hospital, Shizuoka, Japan.
¹⁰ First Department of Medicine, Hamamatsu University of School of Medicine, Shizuoka, Japan.
¹¹ Department of Internal Medicine II, Hamamatsu University School of Medicine, Shizuoka, Japan.
¹² Department of Gastroenterology, Hamamatsu Medical Center, Shizuoka, Japan.
¹³ Department of Gastroenterology and Hepatology, International University of Health and Welfare Atami Hospital, Shizuoka, Japan.
¹⁴ Department of Gastroenterology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.
¹⁵ Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan.

PMID: 39643517
DOI: 10.1016/j.pan.2024.11.022

Abstract

Background/objectives: The detection of pancreatic cancer (PC) often depends on indirect indicators such as parenchyma atrophy (PPA), main pancreatic duct stenosis, and low echoic areas, particularly when no mass is evident on imaging. While pathological evaluation is the gold standard for differentiating malignant from benign conditions, endoscopic ultrasound-guided fine-needle aspiration/biopsy is not always feasible in such cases. Serial pancreatic juice aspiration cytologic examination (SPACE) via endoscopic nasopancreatic drainage (NPD) has emerged as an alternative diagnostic method, though its accuracy remains underevaluated. This study aimed to evaluate the diagnostic performance of SPACE and explore strategies to enhance its accuracy in diagnosing PC.

Methods: This multicenter, retrospective study analyzed patients who underwent SPACE between January 2015 and September 2023. The inclusion criteria focused on cases lacking a clear pancreatic mass but exhibiting indirect signs suggestive of PC. Diagnostic accuracy was determined using surgical pathology or a minimum follow-up period of 12 months as the reference standard.

Results: Among 164 patients, 85 (51.8 %) were diagnosed with malignancy. The sensitivity and specificity of SPACE were 74.1 % and 87.3 %, respectively, with a area under the receiver operating characteristic curve (ROC-AUC) of 0.807 (95%CI: 0.748-0.867). Incorporating patient age, CEA and PPA with SPACE results further improved diagnostic performance, yielding a ROC-AUC of 0.828 (95%CI: 0.76-0.897, p = 0.013).

Conclusions: Combining SPACE with clinical and imaging findings significantly enhances diagnostic accuracy in suspected PC cases where conventional imaging fails to detect tumors. This integrated approach has the potential to enhance clinical outcomes by facilitating more accurate patient management.

Keywords: Carcinoma in situ; Early diagnosis; Pancreatic cancer; Pancreatic juice; Pancreatic neoplasms.