Differentiation of small pancreatic mass lesions by the combination of endosonography and genetic analysis of purepancreatic juice

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Background & Aims : The early diagnosis of pancreatic cancer is still difficult. The purpose of this prospective study was to assess the utility of a combination of endosonography and genetic analysis of pure pancreatic juice for the early recognition of pancreatic cancer. Methods : One hundred and seventy-six patients with syspected pancreatic injury were enrolled and underwent endosonography. Pure pancreatic juice was collected endoscopically in patients with solid pancreatic masses. K-ras point mutations at codon 12 in the juice were assayd by polymerase chain reaction-restriction fragment length polymorphism. Results : Thirty-six patients (20%) were found to have solid pancreatic masses. They consisted of 19 patients with pancreatic cancer (7 patients, <less than or equal> 2cm) and 17 patients with an inflammatory pancreatic mass (13 patients, <less than or equal> 2cm). Although endoscopic retrograde cholangiopancreatography showed high accuracy for cancer diagnosis, ultrasonography and computed tomography were less sensitive, particularly in small pancreatic masses, and 65% of them were not disclosed until endosonography. In contrast, endosonography showed high sensitivity (100%) and specificity (92%) even in small masses. Together with K-ras analysis, assayd safely using small samples, the endosonographic diagnosis became more definitive. Conclusions : Both endosonography and K-ras analysis was safely performed. The combination of endosonography and K-ras analysis of pure pancreatic juice may be useful for the early diagnosis of pancre