Pancreatic duct cytology, an underused diagnostic tool

Cytological brushing of the main pancreatic duct during endoscopic retrograde cholangiopancreatography (ERCP) could be an option in the diagnosis of pancreatic malignancies. However, the historical low sensitivity of biliary cytology for detecting malignancy, the difficulty in crossing pancreatic strictures and the potential for postprocedure pancreatitis, has limited the use of pancreatic ductal cytology (PDC) during ERCP. Preliminary data suggest that cytological brushing of pancreatic duct is safe and has an equal or slightly superior sensitivity comparing to biliary brushing, although its clinical application has not been defined [ , ]. In recent guidelines published by ESGE, EUS-guided pancreatic cytology (EUS-FNA) was reinforced as the method of choice for the cytopathological diagnosis of pancreatic solid lesions (sensitivity and specificity, 85%–89% and 96%–99%, respectively) [ ]. In cases of negative or inconclusive results with a high degree of suspicion for malignancy, it is suggested to re-evaluate the cytology specimens, repeat EUS-guided sampling, or refer to surgery [ ]. This justifies the low utilization of PDC in the diagnosis of these tumors. However, when priority is relief of jaundice due to compression of the common bile duct in which there is a concurrent narrowing of the pancreatic duct, PDC may be viewed as a relevant tool besides biliary cytology.