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Cited by 24Pancreatic and Hepatic Oncology ResearchPancreatitis Pathology and TreatmentGallbladder and Bile Duct Disorders

The DOI matches its Crossref record; 15 of the 15 references it cites were found in a registry or an index.

Predictive Value of Localized Stenosis of the Main Pancreatic Duct for Early Detection of Pancreatic Cancer

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Kanno, Yoshihide, Koshita, Shinsuke, Ogawa, Takahisa, Kusunose, Hiroaki, Masu, Kaori, Sakai, Toshitaka, Yonamine, Keisuke, Kawakami, Yujiro, Fujii, Yuki, Miyamoto, Kazuaki, Murabayashi, Toji, Kozakai, Fumisato, Horaguchi, Jun, Noda, Yutaka, Oikawa, Masaya, Okada, Takaho, Ito, Kei·2019·Clinical Endoscopy
DOI 10.5946/ce.2019.018PMC PMC6900300
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Abstract

BACKGROUND/AIMS: In this study, we aimed to evaluate the predictive value of localized stenosis of the main pancreatic duct (MPD) for early detection of pancreatic cancer. METHODS: Among 689 patients who underwent endoscopic retrograde pancreatography from January 2008 to September 2018, 19 patients with MPD findings were enrolled. These patients showed findings for indicating suspicious pancreatic cancer at an early stage (FiCE); FiCE was defined as a single, localized stenosis in the MPD without a detectable mass (using any other imaging methods) and without other pancreatic diseases, such as definite chronic pancreatitis, intraductal papillary mucinous neoplasm, and autoimmune pancreatitis. Final diagnoses were established by examining resected specimens or through follow-up examinations after an interval of >5 years. RESULTS: Among 19 patients with FiCE, 11 underwent surgical resection and 8 were evaluated after a >5-year observation period. The final diagnosis of the MPD stenosis was judged to be pancreatic cancer in 9 patients (47%), including 3 with intraepithelial cancer, and to be a non-neoplastic change in 10. The sensitivity, specificity, and accuracy of preoperative pancreatic juice cytology were 75%, 100%, and 88%, respectively. CONCLUSION: The predictive value of FiCE for pancreatic cancer prevalence was 47%. Histological confirmation with pancreatic juice cytology is necessary before surgical resection.

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Figures

Fig. 1. Study flow chart. AIP, autoimmune pancreatitis; CT, computed tomography; ERP, endoscopic retrograde pancreatography; EUS, endoscopic ultrasonography; FiCE, findings for indicating suspicious pancreatic cancer at an early stage; IPMN, intraductal papillary mucinous neoplasms; MPD, main pancreatic duct; MRI, magnetic resonance imaging.
Fig. 1. Study flow chart. AIP, autoimmune pancreatitis; CT, computed tomography; ERP, endoscopic retrograde pancreatography; EUS, endoscopic ultrasonography; FiCE, findings for indicating suspicious pancreatic cancer at an early stage; IPMN, intraductal papillary mucinous neoplasms; MPD, main pancreatic duct; MRI, magnetic resonance imaging.CC BY-NC · PubMed Central
Fig. 2. Endoscopic retrograde pancreatography in patients diagnosed with malignant main pancreatic duct (MPD) stenosis with (findings for indicating suspicious pancreatic cancer at an early stage) without masses that are detectable via other imaging examinations. (A-I) show cases #1–#9 (Table 2) in a sequential order. (B, E, F) (Cases #2, #5, and #6, respectively) were obtained after a catheter was advanced into the tail side of the MPD along a guidewire, although contrast was not injected into the tail side as the catheter could not be advanced beyond the stenosis. Arrowheads indicate stenosis of the MPD.
Fig. 2. Endoscopic retrograde pancreatography in patients diagnosed with malignant main pancreatic duct (MPD) stenosis with (findings for indicating suspicious pancreatic cancer at an early stage) without masses that are detectable via other imaging examinations. (A-I) show cases #1–#9 (Table 2) in a sequential order. (B, E, F) (Cases #2, #5, and #6, respectively) were obtained after a catheter was advanced into the tail side of the MPD along a guidewire, although contrast was not injected into the tail side as the catheter could not be advanced beyond the stenosis. Arrowheads indicate stenosis of the MPD.CC BY-NC · PubMed Central
Fig. 3. Endoscopic retrograde pancreatography and magnetic resonance cholangiopancreatography (MRCP) in patients diagnosed with benign main pancreatic duct (MPD) stenosis with (findings for indicating suspicious pancreatic cancer at an early stage) without masses that are detectable via other imaging examinations. (A-I) show Cases #10–#18 (Table 2) in a sequential order. Because neither contrast nor a catheter could be advanced to the tail side of the MPD in Case #12, MRCP is additionally shown to show tail-side pancreatography (C). (B, D, J) (Cases #11, #13, and #17, respectively) were obtained after a catheter was advanced into the tail side of the MPD along a guidewire, although contrast was not injected into the tail side before the catheter was advanced beyond the stenosis.
Fig. 3. Endoscopic retrograde pancreatography and magnetic resonance cholangiopancreatography (MRCP) in patients diagnosed with benign main pancreatic duct (MPD) stenosis with (findings for indicating suspicious pancreatic cancer at an early stage) without masses that are detectable via other imaging examinations. (A-I) show Cases #10–#18 (Table 2) in a sequential order. Because neither contrast nor a catheter could be advanced to the tail side of the MPD in Case #12, MRCP is additionally shown to show tail-side pancreatography (C). (B, D, J) (Cases #11, #13, and #17, respectively) were obtained after a catheter was advanced into the tail side of the MPD along a guidewire, although contrast was not injected into the tail side before the catheter was advanced beyond the stenosis.CC BY-NC · PubMed Central
Fig. 4. Cancer invasion, with the invasive region being 27 mm in size (Case #9 in Table 2). (A) Mapping through divided faces; (B) Mapping through cutting lines; (C) Microscopic examination of hematoxylin-eosin-stained specimen (×10) showing a whitish, hard region, indicating that invasive cancer was not identified macroscopically on the divided faces. Microscopic evaluation shows that the invasive region (red color) was not round, dense, or well-demarcated, possibly due to the difficulty in detection during imaging examinations. The invasive region is indicated in red and the high-grade pancreatic intraepithelial neoplasia is indicated in yellow. The white box in (A) indicates the location of (C). The blue arrow indicates the main pancreatic duct near the stenosis.
Fig. 4. Cancer invasion, with the invasive region being 27 mm in size (Case #9 in Table 2). (A) Mapping through divided faces; (B) Mapping through cutting lines; (C) Microscopic examination of hematoxylin-eosin-stained specimen (×10) showing a whitish, hard region, indicating that invasive cancer was not identified macroscopically on the divided faces. Microscopic evaluation shows that the invasive region (red color) was not round, dense, or well-demarcated, possibly due to the difficulty in detection during imaging examinations. The invasive region is indicated in red and the high-grade pancreatic intraepithelial neoplasia is indicated in yellow. The white box in (A) indicates the location of (C). The blue arrow indicates the main pancreatic duct near the stenosis.CC BY-NC · PubMed Central

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  1. c2018, Cancer statistics in Japan; Table download [Internet]

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Metadata

Authors
Kanno, Y., Koshita, S., Ogawa, T., Kusunose, H., Masu, K., Sakai, T., Yonamine, K., Kawakami, Y., Fujii, Y., Miyamoto, K., Murabayashi, T., Kozakai, F., Horaguchi, J., Noda, Y., Oikawa, M., Okada, T., & Ito, K.
Affiliations
Sendai Medical Center (JP)
Corresponding author
Kanno, Yoshihide
ORCID
Venue
Clinical Endoscopy
Publisher
The Korean Society of Gastrointestinal Endoscopy
Published
2019-11-30
Volume
52
Issue
6
Pages
588-597
ISSN
  • 2234-2400 (ISSN-L)
  • 2234-2443
DOI
10.5946/ce.2019.018
PMC
PMC6900300
OpenAlex
W2991140622
Cited by
23
References
15
Citations by year
2026: 4 · 2025: 3 · 2024: 3 · 2023: 3 · 2022: 4 · 2021: 3 · 2020: 2 · 2019: 1
FWCI
1.04
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Endoscopy (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
  • Health Sciences › Medicine › Surgery › Pancreatitis Pathology and Treatment
  • Health Sciences › Medicine › Gastroenterology › Gallbladder and Bile Duct Disorders
Keywords
pancreatic cancer, early detection, main pancreatic duct stenosis, endoscopic retrograde pancreatography, pancreatic juice cytology, diagnostic accuracy, surgical resection

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