A new combination of endoscopic ultrasonography and DNA diagnosis using pancreatic juice for the early detection of pancreatic cancer

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The combination of endoscopic ultrasonography and DNA diagnosis using pancreatic juice for the detection of small pancreatic cancer was evaluated. The patients with upper abdominal pain. abnormal laboratory data or images on the pancreas, or worsening of diabetic control were enrolled in this study. When the findings of a small pancreatic mass or dilated pancreatic duct were detected by endoscopic ultrasonography, the pure pancreatic juice was collected under a duodenofiberscope for the analyzes of k-ras point mutation at codon 12. The pancreatic cancers less than 2 cm in a diameter were clearly visualized as round hypoechoic tumors with irregular margin. The pancreatic ducts were abruptly dilated caudal to the tumors. Although inflammatory pancreatic masses were generally visualized as square-shaped hypoechoic area without compression or encasement of the neighboring pancreatic ducts, the differentiation from small pancreatic cancer was not always complete, particularly when the tumor was round and the size was less than 1 cm. The incidence of k-ras point mutation analyzed by PCR-RFLP method was 78% (29/37) in patients with pancreatic cancer and 9% (5/53) in those with chronic pancreatitis. The correlation between the incidence of k-ras mutation and tumor size/location were not seen. These results suggest that the combination of endoscopic ultrasonography and DNA diagnosis using pancreatic juice is useful and promising to the early detection of pancreatic cancer.