VALUE OF ASPIRATION CYTOLOGY IN DIAGNOSIS BY ERCP

ERCP is of great value in diagnosing malignant pathology of the biliop ancreatic duct system. However, the ERCP endoscopic characteristics in malignant stenosis often lack specificity and are difficult to differ entiate from those of chronic pancreatitis. In these cases histologica l confirmation is essential to diagnosis. With the alm of increasing t he diagnostic possibilities of ERCP in pancreatic cancer - particularl y when associated with chronic pancreatitis - we performed aspiration cytology of pancreatic juice obtained via endoscopic cannulation of th e main pancreatic duct using ERCP in 102 patients with suspected peria mpullar pathology, chronic pancreatitis and/or pancreatic cancer. The diagnostic sensitivity of cytology for pancreatic malignancy was 33.3% , versus 60% for cancer of Vater's papilla. Specificity was 100% in bo th cancers. We observed no false positive results or complications. On combining both techniques, i.e., ERCP and cytology of the pancreatic juice, sensitivity increased to 100% for pancreatic malignancy, 77.7% for chronic pancreatitis (characteristic ERCP radiographic images and absence of neoplastic cells) and 100% in the case of ampullomas. Diffi culties in the differential diagnosis between advanced chronic pancrea titis and pancreatic cancer persist with ERCP alone- In such cases asp iration cytology may secure a definitive diagnosis -particularly when neoplastic cells are demonstrated (Class IV).