{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:59:03Z","timestamp":1760151543298,"version":"build-2065373602"},"reference-count":24,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,3,18]],"date-time":"2022-03-18T00:00:00Z","timestamp":1647561600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>The risk of malignant transformation of intraductal papillary mucinous neoplasm (IPMN) is presently assessed using imaging, which remains unsatisfactory. Given the high viscosity of pancreatic juice, pancreatic juice cytology (PJC) is considered an investigational procedure. We previously demonstrated that the diagnostic performance of PJC was improved via synthetic secretin loading in pancreatic ductal carcinoma. This study aimed to evaluate the efficacy of synthetic secretin-loaded PJC (S-PJC) for IPMN. The usefulness and safety of S-PJC were prospectively evaluated in 133 patients with IPMN. Overall, 92, 12, and 26 patients had branch duct, main duct, and mixed-type lesions, respectively. The risk classifications based on the 2017 international consensus guidelines were high-risk stigmata, worrisome features, and no risk in 29, 59, and 45 patients, respectively. Synthetic secretin loading improved the sensitivity of PJC from 50.0% to 70.8%. Complications included 13 (9.8%) cases of mild pancreatitis, 1 (0.8%) case of acute cholangitis, and 1 (0.8%) case of Mallory\u2013Weiss syndrome, all of which resolved with conservative treatment. In conclusion, synthetic secretin-loaded PJC improved the diagnostic performance of cytology for malignant IPMN. We recommend using synthetic secretin-loaded PJC for the preoperative pathological diagnosis of malignant IPMN in clinical settings.<\/jats:p>","DOI":"10.3390\/diagnostics12030744","type":"journal-article","created":{"date-parts":[[2022,3,20]],"date-time":"2022-03-20T21:26:22Z","timestamp":1647811582000},"page":"744","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Efficacy and Safety of Pancreatic Juice Cytology with Synthetic Secretin in Diagnosing Malignant Intraductal Papillary Mucinous Neoplasms of the Pancreas"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1096-5909","authenticated-orcid":false,"given":"Yohei","family":"Takeda","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5680-4791","authenticated-orcid":false,"given":"Kazuya","family":"Matsumoto","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0310-0720","authenticated-orcid":false,"given":"Takumi","family":"Onoyama","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taro","family":"Yamashita","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4000-6899","authenticated-orcid":false,"given":"Hiroki","family":"Koda","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2220-9916","authenticated-orcid":false,"given":"Wataru","family":"Hamamoto","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuri","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takuya","family":"Shimosaka","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiho","family":"Kawahara","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasushi","family":"Horie","sequence":"additional","affiliation":[{"name":"Division of Organ Pathology, Department of Pathology, Faculty of Medicine, Tottori University, Tottori 680-0000, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hajime","family":"Isomoto","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1016\/j.pan.2017.07.007","article-title":"Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas","volume":"17","author":"Tanaka","year":"2017","journal-title":"Pancreatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/j.pan.2019.02.013","article-title":"Evaluation of efficacy of pancreatic juice cytology for risk classification according to international consensus guidelines in patients with intraductal papillary mucinous neoplasm; a retrospective study","volume":"19","author":"Yamakawa","year":"2019","journal-title":"Pancreatology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12876-020-01465-y","article-title":"The efficacy of pancreatic juice cytology with liquid-based cytology for evaluating malignancy in patients with intraductal papillary mucinous neoplasm","volume":"20","author":"Miyamoto","year":"2020","journal-title":"BMC Gastroenterol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2199","DOI":"10.1016\/j.cgh.2018.12.034","article-title":"Cytologic Analysis of Pancreatic Juice Increases Specificity of Detection of Malignant IPMN\u2013A Systematic Review","volume":"17","author":"Tanaka","year":"2019","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_5","first-page":"382","article-title":"Peritoneal seeding in intraductal papillary mucinous neoplasm of the pancreas patients who underwent endoscopic ultrasound-guided fine-needle aspiration: The PIPE Study","volume":"46","author":"Yoon","year":"2014","journal-title":"Laryngo-Rhino-Otologie"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1159\/000481235","article-title":"Needle Tract Seeding: An Overlooked Rare Complication of Endoscopic Ultrasound-Guided Fine-Needle Aspiration","volume":"93","author":"Minaga","year":"2017","journal-title":"Oncology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1111\/den.12230","article-title":"Diagnostic yield of endoscopic retrograde cholangiopancreatography-based cytology for distinguishing malignant and benign intraductal papillary mucinous neoplasm: Systematic review and meta-analysis","volume":"26","author":"Suzuki","year":"2014","journal-title":"Dig. Endosc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1016\/j.pan.2016.08.009","article-title":"The safety and benefit of pancreatic juice cytology under ERCP in IPMN patients","volume":"16","author":"Yoshioka","year":"2016","journal-title":"Pancreatology"},{"key":"ref_9","first-page":"775","article-title":"The role of pancreatic juice cytology in the diagnosis of pancreatic intraductal papillary mucinous neoplasm","volume":"111","author":"Ozawa","year":"2018","journal-title":"Revista Espa\u00f1ola de Enfermedades Digestivas"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/j.gie.2016.10.017","article-title":"Pancreatic juice cytology with immunohistochemistry to detect malignancy and histologic subtypes in patients with branch duct type intraductal papillary mucinous neoplasms of the pancreas","volume":"85","author":"Koshita","year":"2017","journal-title":"Gastrointest. Endosc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"656","DOI":"10.4251\/wjgo.v8.i9.656","article-title":"Role of the preoperative usefulness of the pathological diagnosis of pancreatic diseases","volume":"8","author":"Matsumoto","year":"2016","journal-title":"World J. Gastrointest. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2610","DOI":"10.1002\/1097-0142(19921201)70:11<2610::AID-CNCR2820701107>3.0.CO;2-Y","article-title":"Cytologic examination of pure pancreatic juice in the diagnosis of pancreatic carcinoma. The endoscopic retrograde intraductal catheter aspiration cytologic technique","volume":"70","author":"Nakaizumi","year":"1992","journal-title":"Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1111\/den.13203","article-title":"Efficacy and Safety of Pancreatic Juice Cytology by Using Synthetic Secretin in the Diagnosis of Pancreatic Ductal Adenocarcinoma","volume":"30","author":"Takeda","year":"2018","journal-title":"Dig. Endosc."},{"key":"ref_14","unstructured":"Gill, A.J., Klimstra, D.S., and Lam, A.K. (2019). Tumours of the Pancreas. World Health Organization Classification of Tumours, Digestive System Tumours, IARC. [5th ed.]."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/S0016-5107(91)70740-2","article-title":"Endoscopic sphincterotomy complications and their management: An attempt at consensus","volume":"37","author":"Cotton","year":"1991","journal-title":"Gastrointest. Endosc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1038\/bmt.2012.244","article-title":"Investigation of the Freely Available Easy-to-Use Software \u2018EZR\u2019 for Medical Statistics","volume":"48","author":"Kanda","year":"2013","journal-title":"Bone Marrow Transpl."},{"key":"ref_17","first-page":"1","article-title":"Clinical Impact of the KL-6 Concentration of Pancreatic Juice for Diagnosing Pancreatic Masses","volume":"2015","author":"Matsumoto","year":"2015","journal-title":"BioMed Res. Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.1136\/gutjnl-2015-311166","article-title":"Digital next-generation sequencing identifies low-abundance mutations in pancreatic juice samples collected from the duodenum of patients with pancreatic cancer and intraductal papillary mucinous neoplasms","volume":"66","author":"Yu","year":"2017","journal-title":"Gut"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3134","DOI":"10.1007\/s00330-014-3355-y","article-title":"Does secretin stimulation add to magnetic resonance cholangiopancreatography in characterising pancreatic cystic lesions as side-branch intraductal papillary mucinous neoplasm?","volume":"24","author":"Purysko","year":"2014","journal-title":"Eur. Radiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2994","DOI":"10.1007\/s00268-014-2684-y","article-title":"Role of Pancreatic Juice Cytology in the Preoperative Management of Intraductal Papillary Mucinous Neoplasm of the Pancreas in the Era of International Consensus Guidelines","volume":"38","author":"Ohtsuka","year":"2014","journal-title":"World J. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1097\/01.sla.0000128306.90650.aa","article-title":"Intraductal Papillary Mucinous Neoplasms of the Pancreas: An Updated Experience","volume":"239","author":"Sohn","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1002\/jhbp.878","article-title":"Natural history and optimal treatment strategy of intraductal papillary mucinous neoplasm of the pancreas: Analysis using a nomogram and Markov decision model","volume":"28","author":"Han","year":"2021","journal-title":"J. Hepato-Biliary-Pancreatic Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1159\/000090023","article-title":"International Consensus Guidelines for Management of Intraductal Papillary Mucinous Neoplasms and Mucinous Cystic Neoplasms of the Pancreas","volume":"6","author":"Tanaka","year":"2006","journal-title":"Pancreatology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.pan.2012.04.004","article-title":"International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas","volume":"12","author":"Tanaka","year":"2012","journal-title":"Pancreatology"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/3\/744\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:39:11Z","timestamp":1760135951000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/3\/744"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,18]]},"references-count":24,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["diagnostics12030744"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics12030744","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2022,3,18]]}}}