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Intraductal Papillary Mucinous Neoplasm of the Pancreas pp 103–113Cite as

Diagnostic Investigation Using Pancreatic Juice

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Abstract

Although endoscopic retrograde pancreatography to collect pancreatic juice sample for intraductal papillary mucinous neoplasms (IPMNs) of the pancreas is not routinely recommended because of its possible severe complication of pancreatitis, assessments of cytology and molecular markers in pancreatic juice are often useful to diagnose malignant IPMNs. In addition, pancreatic juice cytology is the only way to detect early stage pancreatic ductal adenocarcinoma concomitant with IPMNs which cannot be detected by imaging modalities such as computed tomography, magnetic resonance imaging, or endoscopic ultrasonography. The sensitivity of pancreatic juice cytology for malignant IPMNs is not high, ranging from 10 % to 50 %; however, several molecular markers in pancreatic juice such as carcinoembryonic antigen level, MUC1 level, and the activity of telomerase improve the sensitivity. Pancreatic juice cytology also provides the information regarding subtypes of IPMNs, namely, gastric, intestinal, pancreatobiliary, and oncocytic by the assessments of morphological features and immunohistochemistry. On the other hand, it remains unclear which patients with IPMN are indication for pancreatic juice assessment and which patients really get benefits of such investigation.

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References

  • Ahmed K, Sussman JJ, Wang J, et al. A case of EUS-guided FNA-related pancreatic cancer metastasis to the stomach. Gastrointest Endosc. 2011;74:231–3.

    Article  PubMed  Google Scholar 

  • Chong A, Venugopal K, Segarajasingam D, et al. Tumor seeding after EUS-guided FNA of the pancreatic tail neoplasia. Gastrointest Endosc. 2011;74:933–5.

    Article  PubMed  Google Scholar 

  • Eguchi H, Ishikawa O, Ohigashi H, et al. Role of intraoperative cytology combined with histology in detecting continuous and skip type intraductal cancer existence for intraductal papillary mucinous carcinoma of the pancreas. Cancer. 2006;107:2567–75.

    Article  PubMed  Google Scholar 

  • Furukawa T, Klöppel G, Adsay V, et al. Classification of types of intraductal papillary-mucinous neoplasm of the pancreas: a consensus study. Virchows Arch. 2005;447:794–9.

    Article  PubMed  Google Scholar 

  • Furukawa T, Hatori T, Fujita I, et al. Prognostic relevance of morphological types of intraductal papillary mucinous neoplasms of the pancreas. Gut. 2011;60:509–16.

    Article  PubMed  Google Scholar 

  • Hibi Y, Fukushima N, Tsuchida A, et al. Pancreatic juice cytology and subclassification of intraductal papillary mucinous neoplasms of the pancreas. Pancreas. 2007;34:197–204.

    Article  PubMed  Google Scholar 

  • Hirono S, Tani M, Kawai M, et al. Treatment strategy for intraductal papillary mucinous neoplasm of the pancreas based on malignant predictive factors. Arch Surg. 2009;144:345–9.

    Article  PubMed  CAS  Google Scholar 

  • Hirono S, Tani M, Kawai M, et al. The carcinoembryonic antigen level in pancreatic juice and mural nodule size are predictors of malignancy of branch duct type intraductal papillary mucinous neoplasms of the pancreas. Ann Surg. 2012;255:517–22.

    Article  PubMed  Google Scholar 

  • Inoue H, Tsuchida A, Kawasaki Y, et al. Preoperative diagnosis of intraductal papillary-mucinous tumors of the pancreas with attention to telomerase activity. Cancer. 2001;91:35–41.

    Article  PubMed  CAS  Google Scholar 

  • Jiang P, Watanabe H, Okada G, et al. Diagnostic utility of aberrant methylation of tissue factor pathway inhibitor 2 in pure pancreatic juice for pancreatic carcinoma. Cancer Sci. 2006;97:1267–73.

    Article  PubMed  CAS  Google Scholar 

  • Judah JR, Draganov PV. Intraductal biliary and pancreatic endoscopy: an expanding scope of possibility. World J Gastroenterol. 2008;14:3129–36.

    Article  PubMed  Google Scholar 

  • Watanabe H, Okada G, Ohtsubo K, et al. Aberrant methylation of secreted apoptosis-related protein 2 (SARP2) in pure pancreatic juice in diagnosis of pancreatic neoplasms. Pancreas. 2006;32:382–9.

    Article  PubMed  Google Scholar 

  • Kaino M, Kondoh S, Okita S, et al. Detection of K-ras and p53 gene mutations in pancreatic juice for the diagnosis of intraductal papillary mucinous tumors. Pancreas. 1999;18:294–9.

    Article  PubMed  CAS  Google Scholar 

  • Kanda M, Knight S, Topazian M, et al. Mutant GNAS detected in duodenal collections of secretin-stimulated pancreatic juice indicates the presence or emergence of pancreatic cysts. Gut. 2013; 62:1024–33.

    Google Scholar 

  • Katanuma A, Maguchi H, Hashigo S, et al. Tumor seeding after endoscopic ultrasound-guided fine-needle aspiration of cancer in the body of the pancreas. Endoscopy. 2012;44:E160–161.

    Article  PubMed  Google Scholar 

  • Kondo H, Sugano K, Fukayama N, et al. Detection of K-ras gene mutations at codon 12 in the pancreatic juice of patients with intraductal papillary mucinous tumors of the pancreas. Cancer. 1997;79:900–5.

    Article  PubMed  CAS  Google Scholar 

  • Kucera S, Centeno BA, Springett G, et al. Cyst fluid carcinoembryonic antigen level is not predictive of invasive cancer in patients with intraductal papillary mucinous neoplasm of the pancreas. J Periodontol. 2012;13:409–13.

    Google Scholar 

  • Marie F, Voitot H, Aubert A, et al. Intraductal papillary mucinous neoplasms of the pancreas: performance of pancreatic fluid analysis for positive diagnosis and the prediction of malignancy. Am J Gastroenterol. 2008;103:2871–7.

    Article  Google Scholar 

  • Mino-Kenudson M, Fernández-del Castillo C, Baba Y, et al. Prognosis of invasive intraductal papillary mucinous neoplasm depends on histological and precursor epithelial subtypes. Gut. 2011;60:1712–20.

    Article  PubMed  Google Scholar 

  • Mizuno O, Kawamoto H, Yamamoto N, et al. Single-pattern convergence of K-ras mutation correlates with surgical indication of intraductal papillary mucinous neoplasms. Pancreas. 2010;39:617–21.

    Article  PubMed  Google Scholar 

  • Mori Y, Ohtsuka T, Tsutsumi K, et al. Multifocal pancreatic ductal adenocarcinomas concomitant with intraductal papillary mucinous neoplasms of the pancreas detected by intraoperative pancreatic juice cytology. A case report. J Periodontol. 2010;11:389–92.

    Google Scholar 

  • Mori Y, Ohtsuka T, Kono H, et al. A minimally invasive and simple screening test for detection of pancreatic ductal adenocarcinoma using biomarkers in duodenal juice. Pancreas. 2013;42:187–92.

    Google Scholar 

  • Ohtsuka T, Ideno N, Aso T, et al. Role of endoscopic retrograde pancreatography to detect early pancreatic ductal carcinoma concomitant with intraductal papillary mucinous neoplasm of the pancreas. J Hepatobiliary Pancreat Sci. 2013;20:356–61.

    Google Scholar 

  • Ohuchida K, Mizumoto K, Yamada D, et al. Quantitative analysis of human telomerase reverse transcriptase in pancreatic cancer. Clin Cancer Res. 2006a;12:2066–9.

    Article  PubMed  CAS  Google Scholar 

  • Ohuchida K, Mizumoto K, Fujita H, et al. Sonic hedgehog is an early development marker of intraductal papillary mucinous neoplasms: clinical implications of mRNA levels in pancreatic juice. J Pathol. 2006b;210:42–8.

    Article  PubMed  CAS  Google Scholar 

  • Ohuchida K, Mizumoto K, Egami T, et al. S100P is an early developmental marker of pancreatic carcinogenesis. Clin Cancer Res. 2006c;12:5411–6.

    Article  PubMed  CAS  Google Scholar 

  • Ohuchida K, Mizumoto K, Ohhashi S, et al. S100A11, a putative tumor suppressor gene, is overexpressed in pancreatic carcinogenesis. Clin Cancer Res. 2006d;12:5417–22.

    Article  PubMed  CAS  Google Scholar 

  • Ohuchida K, Mizumoto K, Yu J, et al. S100A6 is increased in a stepwise manner during pancreatic carcinogenesis: clinical value of expression analysis in 98 pancreatic juice samples. Cancer Epidemiol Biomarkers Prevent. 2006e;16(649):654.

    Google Scholar 

  • Ohuchida K, Mizumoto K, Ohhashi S, et al. Twist, a novel oncogene, is upregulated in pancreatic cancer: clinical implication of Twist expression in pancreatic juice. Int J Cancer. 2006f;120:1634–40.

    Article  Google Scholar 

  • Paquin SC, Gariépy G, Lepanto L, et al. A first report of tumor seeding because of EUS-guided FNA of a pancreatic adenocarcinoma. Gastrointest Endosc. 2005;61:610–1.

    Article  PubMed  Google Scholar 

  • Poultsides GA, Reddy S, Cameron JL, et al. Histopathologic basis for the favorable survival after resection of intraductal papillary mucinous neoplasm-associated invasive adenocarcinoma of the pancreas. Ann Surg. 2010;251:470–6.

    Article  PubMed  Google Scholar 

  • Sadakari Y, Ohuchida K, Nakata K, et al. Invasive carcinoma derived from non-intestinal type intraductal papillary mucinous neoplasm of the pancreas has a poorer prognosis than that derived from intestinal type. Surgery. 2010;147:812–7.

    Article  PubMed  Google Scholar 

  • Salla C, Chatzipantelis P, Konstantinou P, et al. Endoscopic ultrasound-guided fine-needle aspiration cytology in the diagnosis of intraductal papillary mucinous neoplasms of the pancreas. A study of 8 cases. J Periodontol. 2007;8:715–24.

    Google Scholar 

  • Shimamoto T, Tani M, Kawai M, et al. MUC1 is a useful molecular marker for malignant intraductal papillary mucinous neoplasms in pancreatic juice obtained from endoscopic retrograde pancreatography. Pancreas. 2010;39:879–83.

    Article  PubMed  CAS  Google Scholar 

  • Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas. An updated experience. Ann Surg. 2004;239:788–99.

    Article  PubMed  Google Scholar 

  • Tanaka M, Yokohata K, Konomi H, et al. Segmental balloon cytology for preoperative localization of in situ pancreatic cancer. Gastrointest Endosc. 1997;46:447–9.

    Article  PubMed  CAS  Google Scholar 

  • Tanaka M, Fernández-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12:183–97.

    Article  PubMed  Google Scholar 

  • Yamaguchi K, Nakamura M, Shirahane K, et al. Pancreatic juice cytology in IPMN of the pancreas. Pancreatology. 2005a;5:416–21.

    Article  PubMed  Google Scholar 

  • Yamaguchi T, Shirai Y, Ishihara T, et al. Pancreatic juice cytology in the diagnosis of intraductal papillary mucinous neoplasm of the pancreas: significance of sampling by peroral pancreatoscopy. Cancer. 2005b;104:2830–6.

    Article  PubMed  Google Scholar 

  • Yopp AC, Katabi N, Janakos M, et al. Invasive carcinoma arising in intraductal papillary mucinous neoplasms of the pancreas. A match control study with conventional pancreatic ductal adenocarcinoma. Ann Surg. 2011;253:968–74.

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

The authors especially thank Dr. Shinichi Aishima and Dr. Yoshinao Oda (Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University) for their supports of cytological assessment of pancreatic juice and preparing the figures (Figs. 8.2c, 8.3, and 8.4) in this chapter.

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Authors and Affiliations

  1. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Takao Ohtsuka & Masao Tanaka

  2. Division of Diagnostic Pathology, Kyushu University Hospital, Fukuoka, Japan

    Fumihiko Ookubo

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  1. Takao Ohtsuka
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  2. Fumihiko Ookubo
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  3. Masao Tanaka
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Corresponding author

Correspondence to Takao Ohtsuka .

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Editors and Affiliations

  1. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan

    Masao Tanaka

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Ohtsuka, T., Ookubo, F., Tanaka, M. (2014). Diagnostic Investigation Using Pancreatic Juice. In: Tanaka, M. (eds) Intraductal Papillary Mucinous Neoplasm of the Pancreas. Springer, Tokyo. https://doi.org/10.1007/978-4-431-54472-2_8

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  • DOI: https://doi.org/10.1007/978-4-431-54472-2_8

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  • Print ISBN: 978-4-431-54471-5

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