PJC improved the diagnostic utility of EUS-FNA for pancreatic tumor. Endoscopic ultrasonography (EUS) is a widely accepted modality for detecting pancreatobiliary diseases, determining the depth of gastrointestinal malignancies, and, often, for visualizing lesions more precisely than other imaging modalities. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) has enhanced the diagnostic

capabilities of EUS by providing additional pathological findings.[1] More than 20 years have passed since the use of EUS-FNA was demonstrated Trichostatin A cost for pancreatic disease,[2] and now, this technique is popular worldwide. However, EUS cannot detect minimally invasive carcinoma, and EUS-FNA cannot be performed for intraductal papillary mucinous carcinoma (IPMC) because of concerns about needle tract seeding.[3, 4] Since the introduction of endoscopic retrograde cholangiopancreatography (ERCP), pancreatic juice cytology (PJC) has yielded sensitivities for pancreatic cancer that have ranged from 33% to 67%.[5, RXDX-106 mw 6] Recently, Uehara et al. have shown the usefulness of PJC for pancreatic cancer.[7] However, whether PJC strengthens the diagnostic power of EUS-FNA for pancreatic masses remains unclear. In the present study, the

diagnostic ability of EUS-FNA and/or PJC in pancreatic disease was examined. A total of 161 patients (103 men, 58 women; age range, 24–86 years; mean age, 67.0 years) with pancreatic disease was enrolled (Table 1). Of these, 90 patients (54 men, 36 women; age range, 24–86 years; mean age, 65.1 years) had malignant disease, and 71 patients (49 men, 22 women; age range, 28–82 years; mean age, 69.5 years) had benign disease. All patients who underwent EUS-FNA and/or PJC between April 2009 and March 2012 were reviewed. Ten patients were repeated during follow up in some patients

(Table 1). The true number of patients who underwent EUS-FNA, PJC, and both of them are 124, 89, and 36. Patients were referred for EUS-FNA and/or PJC based check details on the need to evaluate them for malignancy. Cytodiagnosis of the specimen was performed by Papanicolaou’s method; rapid cytopathologic diagnosis was not used. Informed consent was obtained from all patients. Eight patients were excluded from EUS-FNA, but not from PJC, if they had thrombocytopenia or uncontrolled coagulopathy. EUS-FNA was not performed for cases of intraductal papillary mucinous neoplasm (IPMN) and IPMC, as it is contraindicated in Japan in such cases. EUS-FNA and PJC were performed in an inpatient endoscopy suite as previously described.[7-11] EUS-FNA was performed using a 7.5-MHz, convex, linear array echoendoscope (GF-UCT240; Olympus Optical Co. Ltd, Tokyo, Japan), a 22-G needle (NA-200H-8022, Olympus), and a 25-G needle (ECHO-25 Cook Medical Inc, Winston-Salem, NC, USA, M00550020; Boston Scientific Corporation, Natick, MA, USA). PJC was performed using a lateral-viewing endoscope (JF260V; Olympus), a cannula (M00535700; Boston Scientific Corporation), and a 0.