Abstract
Pancreatic carcinoma derived from pancreatic duct epithelium (pancreatic ductal carcinoma : PD Ca) is one of the most fatal cancers. Since it is still extremely difficult to detect early PD Ca, many patients with PD Ca will be considered to be unsuitable for surgery when they are diagnosed. At endoscopic retrograde cholangiopancrectography (ERCP) , exfoliated cytologic specimens are obtained from the main pancreatic duct (MPD) via the duodenal papilla by abrasion and aspiration with or without intravenous administration of secretin in Japan. However, the cytologic examination using the previously described techniques yields moderate sensitivity (30-79%) because desquamated ductal epithelial cells are presumably too small in number and too impaired to be accurately diagnosed. In order to obtain a large number of exfoliated cells without alteration from the pancreatic duct, we developed a novel sampling method,“pancreatic duct lavage fluid (PDLF) ”, by devising bronchoalveolar lavage fluid for pulmonary carcinoma. In the present study, cytologic examination using PDLF for diagnosis of PD Ca was evaluated for its usefulness.
We examined 5 patients with PD Ca detected by abdominal CT scan. After brush cytology from the MPD having irregularities, stenosis or obstruction detected by ERCP, PDLF was collected with a catheter. The catheter consists of three parallel lumens for ballooning, injection and a guidewire. Isotonic saline was injected into the injection lumen following ballooning at the MPD, and“PDLF”was simultaneously aspirated from the guidewire lumen.
Cytologic examination using PDLF was sensitive for diagnosis of malignancy compatible with pancreatic adenocarcinoma in all cases. Many exfoliated cells were collected without impairment from PDLF compared to those using brush or aspiration cytology methods. This examination was safely performed without shock, pancreatitis or cholangitis.
Cytologic examination using PDLF is very sensitive for detection of PD Ca and available at any institution equipped with ERCP and cytologic. examination. In the present study, the novel examination.“PDLF”was evaluated as useful, sensitive, safe and not complicated. PDLF could be widely popularized for diagnosis of PD Ca.
