Serial pancreatic juice aspiration cytologic examination for localized main pancreatic duct stenosis

Background and aims:
The efficacy of serial pancreatic juice aspiration cytologic examination (SPACE) for the diagnosis of pancreatic cancer (PC) has been reported. However, the diagnostic ability of SPACE for localized main pancreatic duct stenosis (MPD-s) has not been fully discussed.
Objective:
To evaluate the diagnostic ability of SPACE for MPD-s.
Method:
Of 231 patients who underwent SPACE for MPD-s between April 2011 and December 2021 at our center, 50 patients with MPD-s of unclear cause who underwent surgical resection or more than 1-year follow-up.
Result:
The cause of MPD-s was PC in 18 (pStage0, 7; pStage I, 11) and benign in 32. MPD-s was located at pancreatic head and body/tail in 11 and 39, respectively. ERCP was totally conducted 75 times, and ENPD was successfully placed in 74(99%). Cytological evaluation was conducted the median number of 6 (range, 2-12) times per an ENPD, and total number of cytological evaluation was 482. Sample acquisition rates per a cytology and an ENPD were 66% (319/482) and 96% (71/74), respectively. The diagnostic ability of SPACE was as follows; 47%(8/17) of sensitivity, 94%(30/32) of specificity, 100%(8/8), and 73%(30/41) of accuracy. Adverse events were observed in 17%(13/75; mild pancreatitis).
Conclusion:
The diagnostic ability was high though some improvements are required for the better sensitivity and safety.