This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (33)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Liver/ Biliary Tract/ Pancreatic Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Tetsuya Kaneko, MD; Akimasa Nakao, MD; Shuji Nomoto, MD; Tsuyoshi Furukawa, MD; Yoshiki Hirooka, MD; Nobuo Nakashima, MD; Tetsuro Nagasaka, MD

Arch Surg. 1998;133:263-267.

Objective  To evaluate the diagnostic accuracy of intraoperative pancreatoscopy with the ultrathin pancreatoscope for the main pancreatic lesions of mucin-producing tumors of the pancreas (MPT).

Design  Prospective diagnostic test study with a criterion standard of pathologic examination and masked comparison.

Setting  A university hospital.

Patients  Twenty-four consecutive patients with MPT referred for surgery in whom endoscopic retrograde pancreatography, endoscopic ultrasonography, and computed tomography had been performed as a diagnostic examination. All patients underwent surgery and the diagnosis was confirmed by pathologic examination.

Intervention  Intraoperative pancreatoscopy was performed with the ultrathin pancreatoscope.

Main Outcome Measures  Findings of intraoperative pancreatoscopy, endoscopic retrograde pancreatography, and endoscopic ultrasonography were confirmed by pathologic examination of resected specimens. The diagnostic accuracy of these 3 modalities in detection of MPT lesions in the main pancreatic duct was compared.

Results  The diagnostic criterion of MPT lesions in the main pancreatic duct by intraoperative pancreatoscopy was a granular and papillary mural nodule. An MPT lesion in the main pancreatic duct was found in 17 of 24 cases. Intraoperative pancreatoscopy detected 10 cases of intraductal MPT lesions that could not be detected by endoscopic ultrasonography or endoscopic retrograde pancreatography. Five of 10 cases were intraductal multicentric lesions. In 3 of these 5, additional pancreatic resection was performed. For diagnosis of MPT lesions, the sensitivity, specificity, and overall accuracy of intraoperative pancreatoscopy were all 100%; respective values were 43.8%, 100%, and 60.9% for endoscopic retrograde pancreatography and 47%, 100%, and 62.5% for endoscopic ultrasonography.

Conclusions  Intraoperative pancreatoscopy is safe and effective in diagnosing the intrapancreatic duct extension and multicentric lesions of MPT. It provides important information for operative strategy and contributes to successful pancreatic surgery.

From the Departments of Surgery II (Drs Kaneko, Nakao, and Nomoto), Internal Medicine II (Drs Furukawa and Hirooka), and Clinical Laboratory (Drs Nakashima and Nagasaka), Faculty of Medicine, University of Nagoya, Nagoya, Japan.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Management of Mucin-Producing Cystic Neoplasms of the Pancreas
Fritz et al.
The Oncologist 2009;14:125-136.
ABSTRACT | FULL TEXT  

Intraductal papillary mucinous neoplasms of the pancreas: clinical and pathological features and diagnostic approach
Katabi and Klimstra
J. Clin. Pathol. 2008;61:1303-1313.
ABSTRACT | FULL TEXT  

Surgical Management of Intraductal Papillary Mucinous Tumors of the Pancreas: The Role of Routine Frozen Section of the Surgical Margin, Intraoperative Endoscopic Staged Biopsies of the Wirsung Duct, and Pancreaticogastric Anastomosis
Gigot et al.
Arch Surg 2001;136:1256-1262.
ABSTRACT | FULL TEXT