{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T09:44:38Z","timestamp":1769161478385,"version":"3.49.0"},"reference-count":35,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,4,25]],"date-time":"2023-04-25T00:00:00Z","timestamp":1682380800000},"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>Pathological examination by endoscopic ultrasound\u2013fine needle aspiration is not possible in approximately 10% of pancreatic tumor cases. Pancreatic juice cytology (PJC) is considered an alternative diagnostic method. However, its diagnostic capability is insufficient, and PJC has been repeatedly redevised. Serial pancreatic juice aspiration cytological examination (SPACE) and secretin-loaded PJC (S-PJC) have been recently introduced as alternative diagnostic methods. This study aimed to determine the diagnostic capacity and safety of SPACE and S-PJC using a propensity score-matched analysis. The sensitivity, specificity, and accuracy were 75.0%, 100%, and 92.3% for S-PJC, respectively, and 71.4%, 100%, and 92.3% for SPACE, respectively, meaning that there was no significant difference between the groups. Four patients (15.4%) each in the S-PJC and SPACE groups experienced complications, including postendoscopic retrograde cholangiopancreatography, pancreatitis, and cholangitis. Overall, there was no difference in efficacy and safety between the SPACE and S-PJC groups.<\/jats:p>","DOI":"10.3390\/diagnostics13091536","type":"journal-article","created":{"date-parts":[[2023,4,25]],"date-time":"2023-04-25T04:27:02Z","timestamp":1682396822000},"page":"1536","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Pancreatic Juice Cytology Evaluations Using Synthetic Secretin and Serial Pancreatic Juice Aspiration Cytological Examination for the Diagnosis of Pancreatic Ductal Adenocarcinoma"],"prefix":"10.3390","volume":"13","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":"Yuta","family":"Seki","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\/0000-0002-2372-1631","authenticated-orcid":false,"given":"Hiroki","family":"Kurumi","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 683-8504, 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"}]},{"given":"Naoyuki","family":"Yamaguchi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Graduate School of Biological Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.gie.2011.08.049","article-title":"EUS-guided FNA for diagnosis of solid pancreatic neoplasms: A meta-analysis","volume":"75","author":"Hewitt","year":"2012","journal-title":"Gastrointest. Endosc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1177\/2050640616680972","article-title":"Endoscopic ultrasound-guided fine needle aspiration of pancreatic lesions with 22 versus 25 Gauge needles: A meta-analysis","volume":"5","author":"Facciorusso","year":"2017","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1016\/j.gie.2022.01.019","article-title":"Comparative diagnostic performance of end-cutting fine-needle biopsy needles for EUS tissue sampling of solid pancreatic masses: A network meta-analysis","volume":"95","author":"Gkolfakis","year":"2022","journal-title":"Gastrointest. Endosc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1007\/s00535-007-2071-7","article-title":"Utility of pancreatic duct brushing for diagnosis of pancreatic carcinoma","volume":"42","author":"Uchida","year":"2007","journal-title":"J. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1001\/jama.1949.02910040016003","article-title":"Cancer of the biliary tract and pancreas; diagnosis from cytology of duodenal aspirations","volume":"141","author":"Lemon","year":"1949","journal-title":"J. Am. Med. Assoc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1016\/S0016-5085(58)80074-8","article-title":"The diagnosis of cancer of the pancreas, biliary tract, and duodenum by combined cytologic and secretory methods. I. Exfoliative cytology and a description of a rapid method of duodenal intubation","volume":"34","author":"Raskin","year":"1958","journal-title":"Gastroenterology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1016\/S0016-5085(19)32748-9","article-title":"Cytodiagnosis of pancreatic malignant tumors by aspiration, under direct vision, using a duodenal fiberscope","volume":"67","author":"Endo","year":"1974","journal-title":"Gastroenterology"},{"key":"ref_8","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_9","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.gie.2008.09.059","article-title":"Scraping cytology with a guidewire for pancreatic-ductal strictures","volume":"70","author":"Uehara","year":"2009","journal-title":"Gastrointest. Endosc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.gie.2008.04.050","article-title":"Pancreatic-duct-lavage cytology in candidates for surgical resection of branch-duct intraductal papillary mucinous neoplasm of the pancreas: Should the International Consensus Guidelines be revised?","volume":"69","author":"Sai","year":"2009","journal-title":"Gastrointest. Endosc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1097\/MPA.0b013e31823c0b05","article-title":"Value of cytodiagnosis using endoscopic nasopancreatic drainage for early diagnosis of pancreatic cancer: Establishing a new method for the early detection of pancreatic carcinoma in situ","volume":"41","author":"Iiboshi","year":"2012","journal-title":"Pancreas"},{"key":"ref_12","unstructured":"ChiRhoClin Inc. (2023, February 09). ChiRhoStim Indications. Available online: https:\/\/www.chirhoclin.com\/products\/chirhostim-synthetic-human-secretin\/."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.2214\/AJR.20.24857","article-title":"Secretin-Enhanced MRCP: How and Why-AJR Expert Panel Narrative Review","volume":"216","author":"Swensson","year":"2021","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_14","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_15","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_16","first-page":"354","article-title":"The diagnosis of pancreatic cancer by pancreatic juice cytology","volume":"25","author":"Kameya","year":"1981","journal-title":"Acta Cytol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"599","DOI":"10.3892\/mco.2014.277","article-title":"Evaluation of endoscopic cytological diagnosis of unresectable pancreatic cancer prior to and after the introduction of endoscopic ultrasound-guided fine-needle aspiration","volume":"2","author":"Ushijima","year":"2014","journal-title":"Mol. Clin. Oncol."},{"key":"ref_18","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_19","doi-asserted-by":"crossref","unstructured":"Maruta, A., Iwashita, T., Yoshida, K., Uemura, S., Yasuda, I., and Shimizu, M. (2021). Evaluation of preoperative diagnostic methods for resectable pancreatic cancer: A diagnostic capability and impact on the prognosis of endoscopic ultrasound-guided fine needle aspiration. BMC Gastroenterol., 21.","DOI":"10.1186\/s12876-021-01955-7"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1111\/den.14120","article-title":"Clinical dilemma of endoscopic ultrasound-guided fine needle aspiration for resectable pancreatic body and tail cancer","volume":"34","author":"Kitano","year":"2022","journal-title":"Dig. Endosc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1093\/jjco\/hyy190","article-title":"Randomized phase II\/III trial of neoadjuvant chemotherapy with gemcitabine and S-1 versus upfront surgery for resectable pancreatic cancer (Prep-02\/JSAP05)","volume":"49","author":"Motoi","year":"2019","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1111\/jgh.12332","article-title":"Effect of pancreatic juice cytology and\/or endoscopic ultrasound-guided fine-needle aspiration biopsy for pancreatic tumor","volume":"29","author":"Matsumoto","year":"2014","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Ikemoto, J., Serikawa, M., Hanada, K., Eguchi, N., Sasaki, T., Fujimoto, Y., Sugiyama, S., Yamaguchi, A., Noma, B., and Kamigaki, M. (2021). Clinical analysis of early-stage pancreatic cancer and proposal for a new diagnostic algorithm: A multicenter observational study. Diagnostics, 11.","DOI":"10.3390\/diagnostics11020287"},{"key":"ref_24","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_25","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1007\/s00535-012-0684-y","article-title":"Clinical usefulness of repeated pancreatic juice cytology via endoscopic naso-pancreatic drainage tube in patients with pancreatic cancer","volume":"48","author":"Mikata","year":"2013","journal-title":"J. Gastroenterol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1097\/MPA.0000000000002135","article-title":"Diagnostic yield of serial pancreatic juice aspiration cytologic examination with brush cytology for pancreatic ductal stenosis","volume":"51","author":"Mie","year":"2022","journal-title":"Pancreas"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1111\/jgh.13314","article-title":"A comparison of 4-Fr with 5-Fr endoscopic nasopancreatic drainage catheters: A randomized, controlled trial","volume":"31","author":"Mouri","year":"2016","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2927","DOI":"10.2169\/internalmedicine.50.6235","article-title":"Risk factors for post-ERCP pancreatitis in high risk patients who have undergone prophylactic pancreatic duct stenting: A multicenter retrospective study","volume":"50","author":"Ito","year":"2011","journal-title":"Intern. Med."},{"key":"ref_29","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_30","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1097\/MPA.0000000000001021","article-title":"Prospective follow-up study of the recurrence of pancreatic cancer diagnosed at an early stage: The value of endoscopic ultrasonography for early diagnosis of recurrence in the remnant pancreas","volume":"47","author":"Ikemoto","year":"2018","journal-title":"Pancreas"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1038\/s41586-018-0481-8","article-title":"Precancerous neoplastic cells can move through the pancreatic ductal system","volume":"561","author":"Matsukuma","year":"2018","journal-title":"Nature"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"5253","DOI":"10.1038\/onc.2013.29","article-title":"Evolution and dynamics of pancreatic cancer progression","volume":"32","author":"Yachida","year":"2013","journal-title":"Oncogene"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1111\/den.14225","article-title":"Multicenter prospective cohort study of adverse events associated with biliary endoscopic retrograde cholangiopancreatography: Incidence of adverse events and preventive measures for post-endoscopic retrograde cholangiopancreatography pancreatitis","volume":"34","author":"Fujita","year":"2022","journal-title":"Dig. Endosc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1016\/j.pan.2021.07.005","article-title":"Combined use of indomethacin and hydration is the best conservative approach for post-ERCP pancreatitis prevention: A network meta-analysis","volume":"21","author":"Gede","year":"2021","journal-title":"Pancreatology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1016\/S2468-1253(21)00170-9","article-title":"Non-steroidal anti-inflammatory drugs, intravenous fluids, pancreatic stents, or their combinations for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review and network meta-analysis","volume":"6","author":"Akshintala","year":"2021","journal-title":"Lancet Gastroenterol. Hepatol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/9\/1536\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:22:54Z","timestamp":1760124174000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/9\/1536"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,25]]},"references-count":35,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["diagnostics13091536"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13091536","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,25]]}}}