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Predictors and Diagnostic Strategies for Early-Stage Pancreatic Ductal Adenocarcinoma: A Retrospective Study

Kimura, Hideyo MD*; Ohtsuka, Takao MD, PhD*; Matsunaga, Taketo MD*; Watanabe, Yusuke MD*; Tamura, Koji MD*; Ideno, Noboru MD, PhD*; Aso, Teppei MD, PhD*; Miyazaki, Tetsuyuki MD; Osoegawa, Takashi MD; Aishima, Shinichi MD, PhD; Miyasaka, Yoshihiro MD, PhD*; Ueda, Junji MD, PhD*; Ushijima, Yasuhiro MD, PhD§; Igarashi, Hisato MD, PhD; Ito, Tetsuhide MD, PhD; Takahata, Shunichi MD, PhD*; Oda, Yoshinao MD, PhD; Mizumoto, Kazuhiro MD, PhD*; Tanaka, Masao MD, PhD, FACS*

doi: 10.1097/MPA.0000000000000393
Original Articles

Objectives As a strategy to diagnose early-stage pancreatic ductal adenocarcinoma (PDAC) is urgently needed, we aimed to clarify characteristics of early-stage PDAC.

Methods We retrospectively reviewed medical records of 299 consecutive patients who underwent R0 or R1 surgical resection for PDAC between 1994 and 2013 and compared clinical characteristics between patients with early-stage (stages 0–I by Japanese General Rules for Pancreatic Cancer) and advanced-stage (stages II–IV) disease. Diagnostic processes were also analyzed.

Results Twenty-four patients (8%) had early-stage PDAC (stage 0: 11; stage I: 13). Univariate and multivariate analyses showed that presence or history of intraductal papillary mucinous neoplasm (P < 0.01), history of pancreatitis (P < 0.01), and presence or history of extrapancreatic malignancies (P = 0.01) independently predicted detection of early-stage PDAC. Cytological examination during endoscopic retrograde pancreatography cytology was ∼65% sensitive in preoperative diagnosis of early-stage PDAC, whereas other imaging modalities were only 29% to 38% sensitive; 9 of 24 early-stage PDACs were diagnosed by endoscopic retrograde pancreatography cytology alone.

Conclusions Endoscopic retrograde pancreatography cytology for patients with intraductal papillary mucinous neoplasm or pancreatitis may help diagnose early-stage PDAC. Surveillance of extrapancreatic malignancies might also provide opportunities to detect early-stage PDAC as a second malignancy.

From the Departments of *Surgery and Oncology, †Anatomic Pathology, ‡Medicine and Bioregulatory Science, and §Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Received for publication July 14, 2014; accepted January 28, 2015.

Reprints: Masao Tanaka, MD, PhD, FACS, Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan (e-mail:

The authors declare no conflict of interest.

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