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Diagnostic strategy for small pancreatic cancer using endoscopic procedures

Kikuyama, MasatakaSatoh, Tatsunori. Pancreatology, suppl. S; Philadelphia Vol. 16, Iss. 4,  (Aug/Sep 2016): S143. DOI:10.1016/j.pan.2016.06.516

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Background : EUS-FNA and repeated pancreatic juice cytology named SPACE (Serial Pancreatic-juice Aspiration Cytologic Examination) are feasible to diagnose small pancreatic cancers. We should discuss which modality is selected for the diagnosis.

Cases : For 3 years, 3 small advanced pancreatic cancers less than 10mm and 4 carcinoma in site (CIS) of the pancreas were experienced. No tumor was identified in all cases on contrast-enhanced CT. However, 3 advanced pancreatic cancers were clearly recognized on EUS, and 2 and 1 of them were diagnosed by EUS-FNA and SPACE, respectively. In 3 among 4 cases of CIS, no tumor was identified on EUS and SPACE was selected to reach the diagnosis of pancreatic cancer. The remaining 1 case of CIS had a pancreas head tumorous lesion with MPD stricture and underwent EUS-FNA with failure of the diagnosis, but obtained the diagnosis of pancreatic cancer by SPACE.

Conclusions : To identify a small pancreatic cancer, EUS is necessary. When the tumor is clearly recognized, EUS-FNA is feasible. In a case with a blurred or no pancreatic tumor but a main pancreatic abnormality, SPACE is recommended with considering the finding as secondary due to CIS. When EUS-FNA is negative for pancreatic cancer in a case with a clear tumor, SPACE could contribute the diagnosis if a main pancreatic duct abnormality exists.