Abstract
BACKGROUND AND STUDY AIMS: Early diagnosis of pancreatic cancer is crucial for improving patient prognosis. However, diagnosing pancreatic cancer in the absence of a distinct mass is challenging due to limitations of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Recent studies have suggested that serial pancreatic juice aspiration cytological examination (SPACE) for focal pancreatic duct stenosis may improve diagnostic yield in cases of pancreatic cancer without obvious mass. The aim of this study was to evaluate efficacy of SPACE in diagnosis of focal pancreatic duct stenosis. PATIENTS AND METHODS: A retrospective analysis of data from patients who underwent SPACE for pancreatic ductal stenosis between January 2017 and January 2023 was performed. Primary outcomes included diagnostic capability (sensitivity, specificity, and accuracy) and safety of SPACE. RESULTS: SPACE was performed on 46 patients with focal pancreatic duct stenosis. Initial cytology demonstrated sensitivity of 45.0%, specificity of 84.6%, and accuracy of 67.3%. In contrast, SPACE yielded a significantly improved sensitivity of 90.0% ( P = 0.006) and an accuracy of 89.1% ( P = 0.045). Sensitivity of SPACE increased with the number of cytological examinations: 45% for one submission; 70% for two; 80% for three; 85% for four; and plateaued at 90% for five or more 5. Adverse events occurred in 19.6% of patients, including pancreatitis (mild in 7, moderate in 1) and one case of guidewire penetration of the pancreatic duct. CONCLUSIONS: SPACE was a valuable method for obtaining pathological specimens of focal pancreatic duct stenosis. It yielded improved diagnostic sensitivity and accuracy compared with initial cytology alone.