Cytologic studies for the diagnosis of pancreatic cancer

Endoscopically obtained fluid from the ampulla of Vater was subjected to cytologic examination in 141 of 159 patients with suspected pancreatic disease, most of whom were undergoing endoscopic retrograde cholangiopancreatography (ERCP) examination. Of 26 patients with proven carcinoma of the pancreas, cannulation of the ampulla was successful in 22, and in 12 of these the cytology was positive (54%). Several technical considerations are suggested to increase the yield of positive cytology. They include aspiration of 3 ml or greater, deep insertion of the cannula, collection of pure pancreatic juice, high suction, and use of a fine intraductal rasp. The diagnostic sensitivity of ERCP alone was 73% in patients with cancer, but in combination with cytology it increased to 85%. The combined evaluation yielded 100% accuracy in 22 cases of cancer in which the ampulla was successfully cannulated. In 51 patients with chronic pancreatitis, and in 75 without proven pancreatic disease, the specificity of cytology was 98% and 97% respectively. The specificity of ERCP in chronic pancreatitis was 94%. Cytology is a useful adjunct to the ERCP examination in the diagnosis of pancreatic carcinoma.