Abstract
Background: A preoperative tissue diagnosis of pancreatic cancer is desirable but difficult to
obtain. Methods: Pancreatic brush cytology, salvage cytology, and collection of pancreatic juice were
attempted prospectively during ERCP in 34 patients with pancreatic cancer and 11 with
chronic pancreatitis. K-ras-2 codon 12 was analyzed for presence and type of point mutations. Results: Brush cytology coupled with salvage cytology had a sensitivity of 74%. The addition
of cytologic analysis of pancreatic juice did not substantially improve sensitivity
(76%). K-ras-2 was mutated in both cancer (87%) and pancreatitis (40%). The specificity for cytology
was 100% and for K-ras-2 mutations 60%. Combining cytology with mutation analysis increased sensitivity
to 93% but reduced the positive predictive value. The negative predictive value never
exceeded 75%. None of the patients with chronic pancreatitis had cancer develop (median
follow-up 60 months). Conclusions: Pancreatic ductal brushing with salvage cytology is useful in the diagnosis of cancer,
whereas cytologic analysis of pancreatic juice can be abandoned. At present, K-ras-2 mutation is not useful for differentiating pancreatic cancer from chronic pancreatitis
or the identification of patients with chronic pancreatitis at risk for malignant
transformation. (Gastrointest Endosc 2001;54:595-9.)
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Value of endoscopic ultrasound guided fine needle aspiration biopsy in the diagnosis of solid pancreatic masses.Gut. 2000; 46: 244-249
- Most human carcinomas of the exocrine pancreas contain mutant c-K-ras genes.Cell. 1988; 53: 549-554
- Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group.New Engl J Med. 1993; 328: 1433-1437
- Pancreatitis and the risk of pancreatic cancer.Pancreas. 1995; 11: 185-189
- The risk of pancreatic cancer following pancreatitis: an association due to confounding?.Gastroenterology. 1997; 113: 587-592
- Brush cytology for pancreatic carcinoma: an analysis of factors influencing results.Gastrointest Endosc. 1996; 44: 300-304
- Current protocols in molecular biology.Green Publishing Association and Willy-Interscience, John Wiley and Sons, New York1988
- Rapid and sensitive nonradioactive detection of mutant K-ras genes via “enriched” PCR amplification.Oncogene. 1991; 6: 1079-1083
- Detection of K-ras mutation in normal and malignant colonic tissues by an Enriched PCR method.Int J Onc. 1994; 4: 391-396
- Combined use of brushing cytology and endoscopic retrograde pancreatography for the early detection of pancreatic cancer.Acta Cytol. 1989; 33: 870-874
- A prospective study of endoscopic pancreatic duct cytology in 34 consecutive patients.Gastrointest Endosc. 1994; 40 ([abstract]): 116
- Diagnosis of pancreatic cancer by K-ras point mutation and cytology of pancreatic juice.Am J Gastroenterol. 1996; 91: 1616-1621
- Comparison of flow cytometry for DNA content and brush cytology for detection of malignancy in pancreaticobiliary strictures.Gastrointest Endosc. 1994; 40: 133-139
- Brush cytology during ERCP for the diagnosis of biliary and pancreatic malignancies.Gastrointest Endosc. 1994; 40: 140-145
- Endoscopic retrograde forceps biopsy and brush cytology of biliary strictures: a prospective study.Gastrointest Endosc. 1995; 42: 520-526
- Triple-tissue sampling at ERCP in malignant biliary obstruction.Gastrointest Endosc. 2000; 51: 383-390
- Endoscopic retrograde brush cytology in patients with primary and secondary malignancies of the pancreas.Gut. 1979; 20: 279-284
- Endoscopic retrograde brush cytology. A new technique.Gastroenterology. 1990; 99: 1475-1479
- Endoscopic transpapillary biopsy for diagnosis of patients with pancreaticobiliary ductal strictures.Am J Gastroenterol. 1993; 88: 1700-1704
- Relative contribution of Ki-ras gene analysis and brush cytology during ERCP for the diagnosis of biliary and pancreatic diseases.Gastrointest Endosc. 1998; 47: 479-485
- Cytologic examination of pure pancreatic juice in the diagnosis of pancreatic carcinoma: the endoscopic retrograde intraductal catheter aspiration cytologic technique.Cancer. 1992; 70: 2610-2614
- Effectiveness of the cytologic examination of pure pancreatic juice in the diagnosis of early neoplasia of the pancreas.Cancer. 1995; 76: 750-757
- Accuracy and complication rate of brush cytology from bile duct versus pancreatic duct.Gastrointest Endosc. 1999; 49: 322-327
- Tissue sampling at endoscopic retrograde cholangiopancreatography in suspected pancreatic cancer.Gastrointest Endosc Clin N Am. 1998; 8: 221-235
- Detection of K-ras point mutations at codon 12 in pure pancreatic juice for the diagnosis of pancreatic cancer by PCR-RFLP analysis.Pancreas. 1996; 12: 18-24
- The establishment of a preoperative diagnosis of pancreatic carcinoma using cell specimens from pancreatic duct brushing with special attention to p53 mutations.Cancer. 1998; 82: 1487-1494
- Endoscopic needle aspiration biopsy at ERCE in the diagnosis of biliary strictures.Gastrointest Endosc. 1992; 88: 531-535
- Value of endobiliary brush cytology and biopsies for the diagnosis of malignant bile duct stenosis: results of a prospective study.Gastrointest Endosc. 1995; 42: 565-572
- Diagnosis of cancer by cytologic methods performed during ERCP.Gastrointest Endosc. 1994; 40: 249-252
- Yield of ERCP tissue sampling of malignant strictures by brush, forceps, and needle aspiration methods.Gastrointest Endosc. 1996; 43 ([abstract]): 384
- An in vitro, randomized, prospective study to maximize cellular yield during bile duct brush cytology.Gastrointest Endosc. 1994; 40: 146-149
- Preoperative differentiation between carcinoma of the pancreas and chronic pancreatitis. The contribution of cytology.Endoscopy. 1982; 14: 171-173
- Cytodiagnosis of pancreatic malignant tumors by aspiration under direct vision, using a duodenal fiberscope.Gastroenterology. 1974; 67: 944-951
- A prospective controlled study comparing brush and bile exfoliative cytology for diagnosing bile duct strictures.Gut. 1992; 33: 1675-1677
- Long-term follow-up of patients with chronic pancreatitis and k-ras gene mutation detected in pancreatic juice.Gastroenterology. 1997; 113: 593-598
- K-ras mutations and benign pancreatic disease.Int J Pancreatol. 2000; 27: 93-103
- Pancreatitis is a risk factor for pancreatic cancer.Gastroenterology. 1995; 109: 247-251
Article info
Publication history
Accepted:
August 3,
2001
Received in revised form:
January 18,
2001
Received:
July 14,
2000
Footnotes
☆Supported in part by the University of Genoa, Genova, Italy; CNR PF Target Project on Biotechnology 1998; Ministero Sanità RF.96 and RF.98 and MURST Prin 1998.
☆☆Reprint requests: Vittorio Pugliese, MD, Department of Oncology, University of Genoa, Largo R. Benzi 10, 16132 Genova, Italy.
Identification
Copyright
© 2001 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
