Current status of pancreatic juice/pancreatic duct brush cytology and endoscopic ultrasound-guided fine needle aspiration cytology/ biopsy

Abstract

The status of biopsy and cytology of pancreatic tumors has changed significantly since the advent of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Unlike pancreatic juice and pancreatic duct brush cytology, which is mainly used for tumors involving the pancreatic ducts, diagnosis by EUS-FNA includes tumors not involving the pancreatic ducts. However, pancreatic juice and pancreatic duct brush cytology remain useful for the diagnosis of early pancreatic cancer and pancreatic ductal lesions. Attempts have been made to improve diagnostic accuracy by examination of serial pancreatic juice aspiration cytology specimens. Immunohistochemistry and genetic analysis to distinguish between benign and malignant disease and determine the histological type are more easily performed on samples obtained by EUS-FNA than on those obtained from pancreatic juice and pancreatic ductal brush cytology. Rapid on-site cytologic evaluation and other procedures are needed to reduce the inadequate sampling rate of EUS-FNA and increase the amount of tissue collected.