Preoperative differentiation between carcinoma of the pancreas and chronic pancreatitis: the contribution of cytology.

In a prospective study of 54 consecutive patients where carcinoma of the pancreas was suspected, a simple protocol was employed. Each patient had duodenoscopy and pancreatic juice cytology. Those patients with jaundice had cholangiography by percutaneous or endoscopic retrograde technique. Patients who were not jaundiced had endoscopic retrograde cholangiopancreatography. Malignancy, confirmed by histology, was diagnosed in 25 patients. Patients diagnosed to have benign disease have been followed for two years and in none has the diagnosis changed to malignancy. Twenty-one of those with carcinoma were correctly diagnosed on the basis of cholangiograms or pancreatograms but there were three false-positive diagnoses of malignancy. Cytology identified 15 of the 25 with carcinoma; there were no false positive diagnoses. Pancreatic cytology is highly specific for the diagnosis of carcinoma and should be used early. In patients with negative cytology, an acceptable level of accuracy can be achieved by a combination of endoscopy and radiology.