Uehara H, Nakaizumi A, Tatsuta M, Iishi H, Kitamura T, Ohigashi H, Ishikawa O, Takenaka A
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan.
Cancer. 1997 Feb 1;79(3):454-61. doi: 10.1002/(sici)1097-0142(19970201)79:3<454::aid-cncr5>3.0.co;2-i.
Most pancreatic carcinomas are unresectable at the time of diagnosis, but recently the diagnosis of carcinoma in situ of the pancreas has become possible. This diagnosis can be made by the detection of cancer cells in pancreatic juice and the radiographically demonstrated lack of a mass lesion. It has greatly improved the effectiveness of surgery. Carcinoma in situ remains within the pancreatic ductal epithelium and has not yet invaded the parenchyma. However, it has often been difficult to locate carcinoma in situ by conventional diagnostic methods, such as ultrasonography, endoscopic ultrasonography, computed tomography, and endoscopic retrograde pancreatography.
Peroral pancreatoscopy and a new method of cytodiagnosis, pancreatoscopic cytology, were used to analyze 11 patients with carcinoma in situ of the pancreas, 10 with disease in the main duct of the pancreas and 1 with disease in the branch ducts. The results of pancreatoscopic cytology were compared with those of conventional pancreatic juice cytology.
Under peroral pancreatoscopy, carcinoma in situ of the pancreas in the main duct appeared as papillary mucosa, irregular mucosa, or nodular mucosa. Using pancreatoscopic cytology, cancer cells were obtained from all the lesions, allowing a more thorough analysis than pancreatic juice cytology.
Peroral pancreatoscopy and pancreatoscopic cytology are useful for locating and diagnosing carcinoma in situ of the pancreas.
大多数胰腺癌在诊断时无法切除，但近年来胰腺原位癌的诊断已成为可能。这种诊断可通过检测胰液中的癌细胞以及影像学显示无肿块病变来做出。这大大提高了手术的有效性。原位癌仍局限于胰腺导管上皮内，尚未侵犯实质。然而，通过传统诊断方法，如超声检查、内镜超声检查、计算机断层扫描和内镜逆行胰胆管造影，常常难以定位原位癌。
采用经口胰管镜检查和一种新的细胞诊断方法——胰管镜细胞学检查，对11例胰腺原位癌患者进行分析，其中10例病变位于胰腺主胰管，1例位于分支胰管。将胰管镜细胞学检查结果与传统胰液细胞学检查结果进行比较。
在经口胰管镜检查下，主胰管内的胰腺原位癌表现为乳头状黏膜、不规则黏膜或结节状黏膜。使用胰管镜细胞学检查，从所有病变中均获取了癌细胞，比胰液细胞学检查能进行更全面的分析。
经口胰管镜检查和胰管镜细胞学检查有助于定位和诊断胰腺原位癌。
