- Email: [email protected]
Diagnosis of pancreatic carcinoma in situ with endoscopic nasopancreatic drainage
S20
Abstracts / Pancreatology 16 (2016) S1eS192
Methods: A worldwide collaborative multicenter retrospective cohort-study was conducted through the International CAPS Consortium Registry. Data were collected from 10 prospective PDAC surveillance programs in 4 countries (United States, The Netherlands, Italy, Israel) on HRI in whom pancreatic lesions were detected and confirmed by pathologic diagnosis. For this study, all invasive PDAC and HGD (branch-duct (BD) -IPMN with high-grade dysplasia, PanIN3, and main-duct (MD) -IPMN) were analyzed. Univariate and multivariate analyses were used to compare patients with and without proven PDAC/HGD to assess potential predictive indicators, including family history, genetic background, BMI, race, smoking, alcohol use, history of diabetes, and history of pancreatitis. Results: Seventy-six HRI were included (74% from familial PDAC, 26% mutation carriers; mean age 66 (range 42-90), 49% women). Seventy-one individuals had undergone surgery (2 patients had irresectable disease, 69 had resections: 34 distal resection, 18 Whipple only, 6 Whipple followed by completion pancreatectomy, 2 central pancreatectomy, and 9 total pancreatectomy). Additionally, 5 individuals were diagnosed with inoperable PDAC. PDAC and HGD were detected in 42% of FPC relatives and 58% of mutation carriers (P¼0.24). Thirty-three of the 71 operated cases (47%) had PDAC or HGD: 17 PDAC, 4 MD-IPMN, 6 high-grade BD-IPMN, and 6 PanIN3. Additionally, 7 pancreatic neuroendocrine tumors (NET) were detected, including 1 with nodal metastasis. Eight of the 22 (36%) PDAC cases were diagnosed at baseline screening, the remaining 14 (64%) were detected on follow-up (11 resectable and 3 advanced). Interval advanced PDACs in HRI present typically with symptoms. Only female gender (OR 3.3, P¼0.01) was significantly associated with PDAC/HGD. Eight of the 17 (47%) asymptomatic PDAC and 15/16 (94%) of HGD cases detected during surveillance were alive at last follow-up (mean 22 months). Conclusion: Fifty-seven percent of HRI who underwent surgery had clinically relevant pancreatic neoplasms (24% PDAC, 23% HGD, and 10% NET) that were detected and treated within a surveillance program. Mortality may be improved with screening asymptomatic HRI and intervening prior to PDAC development. More research is needed improve selection of patients for surgery and determine optimal surveillance intervals.
S3-4. Diagnosis of pancreatic carcinoma in situ with endoscopic nasopancreatic drainage Tomoyuki Minami, Keiji Hanada, Naomichi Hirano, Akihito Okazaki, Juri Ikemoto Department of Gastroenterology, Onomichi General Hospital, Japan Patients with pancreatic cancer (PC) have a poor prognosis. It is necessary for improvement of long-term patient outcome to diagnose pancreatic cancer at an early stage. Cytodiagnosis multiple times using pancreatic juice by endoscopic nasopancreatic drainage (ENPD) can diagnose pancreatic carcinoma in situ (PCIS). 107 cases were performed ENPD for diagnosis of PC between January 2007 and December 2015 in our hospital, and 59 cases of which were suspected PCIS. In these 59 cases, we investigated diagnostic yield of ENPD cytodiagnosis and ENPD related complication. Main pancreatic duct stenosis and focal branch duct dilatation without apparent tumor lesion were considered as findings suggestive of PCIS by CT, MRCP and EUS. A 5Fr ENPD catheter was placed over the pancreatic duct stenosis in principle. As for ENPD related complication, acute pancreatitis was observed in 4 out of 59 cases. No severe pancreatitis was found. Hyperamylasemia (> ULN3) without pancreatitis was found in 62.7% (37/59). For the pancreatitis incidence depending on the ENPD placing site, no significant difference was observed (papilla side of stenosis: 1/10, caudal side of stenosis: 2/42, without stenosis: 1/7; p¼0.59). PC was found in 17 cases (UICC stage 0: 13 cases, IA: 4 cases). The diagnostic yield of the ENPD cytodiagnosis was sensitivity: 82.4% (14/17), specificity: 100% (42/42), and accuracy: 94.9% (56/59). No significant difference was found for the diagnostic yield depending on the ENPD placing site (sensitivity was papilla side: 2/10, caudal side 14/42, and without stenosis: 0/7; p¼0.16). In 13 cases of PCIS, no pancreatitis was found, and hyperamylasemia was found in 69.2% (9/13). In conclusion, cytodiagnosis multipletimes using pancreatic juice by ENPD should be useful for diagnosis of PCIS.
S3-5. S3-3. US screening for early diagnosis of pancreatic cancer Reiko Ashida Departments of Cancer Survey and Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Disease, Japan The prognosis of pancreatic cancer is still very poor and most pancreatic cancers are in advanced stages at diagnosis. Because of the lack of diagnostic tumor markers for pancreatic cancer in early stages, the main reason for diagnosis of pancreatic cancer is symptoms such as abdominal pain or epigastralgia which may be misdiagnosed as gastritis. Those patients may benefit from transabdominal ultrasound (US) as a noninvasive, first step modality to find pancreatic cancer. However, most patients who have developed any symptoms already have advanced cancers. Therefore, it is necessary to screen the asymptomatic population during annual checkups or follow up appointments for individuals with high risk stigmata, such as pancreatic cysts, a dilated main pancreatic duct, or chronic pancreatitis, using noninvasive methods. US has proven to be a useful tool in the differential diagnosis of pancreatic tumors. US has many advantages such as its noninvasiveness, inexpensiveness, ease of performing and its wide availability in Japan. US can detect not only tumor but also indirect findings such as cysts or distal MPD dilatation. Although US has limitations and is not suited for subjects with a high body mass index, US images can be improved by liquid ingestion or assumption of the sitting position. Moreover, recent improvements of US techniques such as contrast harmonic imaging may offer higher detection rate of small pancreatic cancer. I will discuss the importance and possibilities of US in the diagnostic strategy of pancreatic cancer in early stages.
Value of EUS and follow-up studies in IPMN cases for early diagnosis of pancreatic cancer Takeshi Miyata 2, Masayuki Kitano 1, Shunsuke Omoto 1, Kumpei Kadosaka 1, Ken Kamata 1, Kentaro Yamao 1, Hajime Imai 1, Tomohiko Matsuda 1, Masatoshi Kudo 1, Yoshifumi Takeyam 2 1 Department of Gastroenterology and Hepatology, Kinki University, Japan 2 Department of Surgery, Kinki University, Japan
Background and aim: Pancreatic ductal adenocarcinomas (PDACs) concomitant to or derived from branch duct intraductal papillary mucinous neoplasms (IPMNs) sometimes arise in patients with IPMNs. The usefulness of EUS relative to other imaging methods for detecting these tumors was assessed. Patients and methods: In 2003-2015, 202 consecutive patients with IPMNs were followed up by EUS, ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI). If one of the four modalities showed during follow-up that the cystic lesion had changed or a nodule had appeared, the other three modalities were performed within the following month. The following outcomes were evaluated: (i) frequencies of changes in the IPMNs and the new development of IPMNderived and IPMN-concomitant PDACs during follow-up; (ii) the relative sensitivity with which each imaging modality depicted PDAC during follow-up; (iii) characteristics of patients with IPMN-concomitant PDACs. Results: (i) In 36 of the 202 (17.8%) followed-up patients, changes in the IPMNs were seen during follow-up. Eight IPMN-concomitant PDACs and two IPMN-derived invasive PDACs were developed during follow-up. (ii) EUS, US, CT and MRI achieved depiction of IPMN-concomitant PDACs in 100%, 13%, 38% and 38%, respectively whereas these four modalities achieved depiction of IPMN-derived PDACs in 100%, 50%, 50% and 50%,
Abstracts / Pancreatology 16 (2016) S1eS192
Methods: A worldwide collaborative multicenter retrospective cohort-study was conducted through the International CAPS Consortium Registry. Data were collected from 10 prospective PDAC surveillance programs in 4 countries (United States, The Netherlands, Italy, Israel) on HRI in whom pancreatic lesions were detected and confirmed by pathologic diagnosis. For this study, all invasive PDAC and HGD (branch-duct (BD) -IPMN with high-grade dysplasia, PanIN3, and main-duct (MD) -IPMN) were analyzed. Univariate and multivariate analyses were used to compare patients with and without proven PDAC/HGD to assess potential predictive indicators, including family history, genetic background, BMI, race, smoking, alcohol use, history of diabetes, and history of pancreatitis. Results: Seventy-six HRI were included (74% from familial PDAC, 26% mutation carriers; mean age 66 (range 42-90), 49% women). Seventy-one individuals had undergone surgery (2 patients had irresectable disease, 69 had resections: 34 distal resection, 18 Whipple only, 6 Whipple followed by completion pancreatectomy, 2 central pancreatectomy, and 9 total pancreatectomy). Additionally, 5 individuals were diagnosed with inoperable PDAC. PDAC and HGD were detected in 42% of FPC relatives and 58% of mutation carriers (P¼0.24). Thirty-three of the 71 operated cases (47%) had PDAC or HGD: 17 PDAC, 4 MD-IPMN, 6 high-grade BD-IPMN, and 6 PanIN3. Additionally, 7 pancreatic neuroendocrine tumors (NET) were detected, including 1 with nodal metastasis. Eight of the 22 (36%) PDAC cases were diagnosed at baseline screening, the remaining 14 (64%) were detected on follow-up (11 resectable and 3 advanced). Interval advanced PDACs in HRI present typically with symptoms. Only female gender (OR 3.3, P¼0.01) was significantly associated with PDAC/HGD. Eight of the 17 (47%) asymptomatic PDAC and 15/16 (94%) of HGD cases detected during surveillance were alive at last follow-up (mean 22 months). Conclusion: Fifty-seven percent of HRI who underwent surgery had clinically relevant pancreatic neoplasms (24% PDAC, 23% HGD, and 10% NET) that were detected and treated within a surveillance program. Mortality may be improved with screening asymptomatic HRI and intervening prior to PDAC development. More research is needed improve selection of patients for surgery and determine optimal surveillance intervals.
S3-4. Diagnosis of pancreatic carcinoma in situ with endoscopic nasopancreatic drainage Tomoyuki Minami, Keiji Hanada, Naomichi Hirano, Akihito Okazaki, Juri Ikemoto Department of Gastroenterology, Onomichi General Hospital, Japan Patients with pancreatic cancer (PC) have a poor prognosis. It is necessary for improvement of long-term patient outcome to diagnose pancreatic cancer at an early stage. Cytodiagnosis multiple times using pancreatic juice by endoscopic nasopancreatic drainage (ENPD) can diagnose pancreatic carcinoma in situ (PCIS). 107 cases were performed ENPD for diagnosis of PC between January 2007 and December 2015 in our hospital, and 59 cases of which were suspected PCIS. In these 59 cases, we investigated diagnostic yield of ENPD cytodiagnosis and ENPD related complication. Main pancreatic duct stenosis and focal branch duct dilatation without apparent tumor lesion were considered as findings suggestive of PCIS by CT, MRCP and EUS. A 5Fr ENPD catheter was placed over the pancreatic duct stenosis in principle. As for ENPD related complication, acute pancreatitis was observed in 4 out of 59 cases. No severe pancreatitis was found. Hyperamylasemia (> ULN3) without pancreatitis was found in 62.7% (37/59). For the pancreatitis incidence depending on the ENPD placing site, no significant difference was observed (papilla side of stenosis: 1/10, caudal side of stenosis: 2/42, without stenosis: 1/7; p¼0.59). PC was found in 17 cases (UICC stage 0: 13 cases, IA: 4 cases). The diagnostic yield of the ENPD cytodiagnosis was sensitivity: 82.4% (14/17), specificity: 100% (42/42), and accuracy: 94.9% (56/59). No significant difference was found for the diagnostic yield depending on the ENPD placing site (sensitivity was papilla side: 2/10, caudal side 14/42, and without stenosis: 0/7; p¼0.16). In 13 cases of PCIS, no pancreatitis was found, and hyperamylasemia was found in 69.2% (9/13). In conclusion, cytodiagnosis multipletimes using pancreatic juice by ENPD should be useful for diagnosis of PCIS.
S3-5. S3-3. US screening for early diagnosis of pancreatic cancer Reiko Ashida Departments of Cancer Survey and Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Disease, Japan The prognosis of pancreatic cancer is still very poor and most pancreatic cancers are in advanced stages at diagnosis. Because of the lack of diagnostic tumor markers for pancreatic cancer in early stages, the main reason for diagnosis of pancreatic cancer is symptoms such as abdominal pain or epigastralgia which may be misdiagnosed as gastritis. Those patients may benefit from transabdominal ultrasound (US) as a noninvasive, first step modality to find pancreatic cancer. However, most patients who have developed any symptoms already have advanced cancers. Therefore, it is necessary to screen the asymptomatic population during annual checkups or follow up appointments for individuals with high risk stigmata, such as pancreatic cysts, a dilated main pancreatic duct, or chronic pancreatitis, using noninvasive methods. US has proven to be a useful tool in the differential diagnosis of pancreatic tumors. US has many advantages such as its noninvasiveness, inexpensiveness, ease of performing and its wide availability in Japan. US can detect not only tumor but also indirect findings such as cysts or distal MPD dilatation. Although US has limitations and is not suited for subjects with a high body mass index, US images can be improved by liquid ingestion or assumption of the sitting position. Moreover, recent improvements of US techniques such as contrast harmonic imaging may offer higher detection rate of small pancreatic cancer. I will discuss the importance and possibilities of US in the diagnostic strategy of pancreatic cancer in early stages.
Value of EUS and follow-up studies in IPMN cases for early diagnosis of pancreatic cancer Takeshi Miyata 2, Masayuki Kitano 1, Shunsuke Omoto 1, Kumpei Kadosaka 1, Ken Kamata 1, Kentaro Yamao 1, Hajime Imai 1, Tomohiko Matsuda 1, Masatoshi Kudo 1, Yoshifumi Takeyam 2 1 Department of Gastroenterology and Hepatology, Kinki University, Japan 2 Department of Surgery, Kinki University, Japan
Background and aim: Pancreatic ductal adenocarcinomas (PDACs) concomitant to or derived from branch duct intraductal papillary mucinous neoplasms (IPMNs) sometimes arise in patients with IPMNs. The usefulness of EUS relative to other imaging methods for detecting these tumors was assessed. Patients and methods: In 2003-2015, 202 consecutive patients with IPMNs were followed up by EUS, ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI). If one of the four modalities showed during follow-up that the cystic lesion had changed or a nodule had appeared, the other three modalities were performed within the following month. The following outcomes were evaluated: (i) frequencies of changes in the IPMNs and the new development of IPMNderived and IPMN-concomitant PDACs during follow-up; (ii) the relative sensitivity with which each imaging modality depicted PDAC during follow-up; (iii) characteristics of patients with IPMN-concomitant PDACs. Results: (i) In 36 of the 202 (17.8%) followed-up patients, changes in the IPMNs were seen during follow-up. Eight IPMN-concomitant PDACs and two IPMN-derived invasive PDACs were developed during follow-up. (ii) EUS, US, CT and MRI achieved depiction of IPMN-concomitant PDACs in 100%, 13%, 38% and 38%, respectively whereas these four modalities achieved depiction of IPMN-derived PDACs in 100%, 50%, 50% and 50%,