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Proposal for Endoscopic Ultrasonography Classification for Small Pancreatic Cancer

1
Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 420-8527, Japan
2
Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-0021, Japan
3
Department of Surgery, Shizuoka General Hospital, Shizuoka 420-8527, Japan
4
Department of Surgery, Shinshiro Municipal Hospital, Aichi 441-1387, Japan
5
Department of Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo 113-0021, Japan
6
Department of Pathology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo 113-0021, Japan
7
Department of Human Pathology, Juntendo University, Tokyo 113-8421, Japan
*
Author to whom correspondence should be addressed.
Diagnostics 2019, 9(1), 15; https://doi.org/10.3390/diagnostics9010015
Received: 28 November 2018 / Revised: 18 January 2019 / Accepted: 18 January 2019 / Published: 23 January 2019
(This article belongs to the Special Issue Early Diagnosis of Pancreatic Cancer)
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Abstract

Backgrounds: Endoscopic ultrasonography (EUS) is used to observe the stricture of the main pancreatic duct (MPD) and in diagnosing pancreatic cancer (PC). We investigate the findings on EUS by referring to the histopathological findings of resected specimens. Materials and Methods: Six patients with carcinoma in situ (CIS) and 30 patients with invasive carcinoma of 20 mm or less were included. The preoperative EUS findings were classified as follows. A1: Simple stricture type—no findings around the stricture; A2: Hypoecho stricture type—localized hypoechoic area without demarcation around the stricture; A3: Tumor stricture type—tumor on the stricture; B: Dilation type—the dilation of the pancreatic duct without a downstream stricture; C: Parenchymal tumor type—tumor located apart from the MPD. Results: Classes A1 and A2 consisted of 2 CISs, and 4 invasive carcinomas included two cases smaller than 5 mm in diameter. Most of the cancers classified as A3 or C were of invasive carcinoma larger than 5 mm in diameter. All cancers classified as B involved CIS. Serial pancreatic-juice aspiration cytologic examination (SPACE) was selected for all types of cases, with a sensitivity of 92.0%, while EUS-guided fine needle aspiration cytology (EUS-FNA) was only useful for invasive carcinoma, and its sensitivity was 66.7%. Conclusions: Stricture without a tumor could be a finding for invasive PC and pancreatic duct dilation without a downstream stricture could be a finding indicative of CIS. Carcinoma smaller than 5 mm in diameter could not be recognized by EUS. SPACE had a high sensitivity for diagnosing small PC. View Full-Text
Keywords: pancreatic cancer; small pancreatic cancer; early diagnosis; carcinoma in situ (CIS); endoscopic ultrasonography (EUS); serial pancreatic-juice aspiration cytologic examination; SPACE pancreatic cancer; small pancreatic cancer; early diagnosis; carcinoma in situ (CIS); endoscopic ultrasonography (EUS); serial pancreatic-juice aspiration cytologic examination; SPACE
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Terada, S.; Kikuyama, M.; Kawaguchi, S.; Kanemoto, H.; Yokoi, Y.; Kamisawa, T.; Kuruma, S.; Chiba, K.; Honda, G.; Horiguchi, S.; Nakahodo, J. Proposal for Endoscopic Ultrasonography Classification for Small Pancreatic Cancer. Diagnostics 2019, 9, 15.

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