Serial Pancreatic Juice Aspiration Cytology: Advancing Insights into Early Pancreatic Cancer Diagnosis

다국어 초록 (Multilingual Abstract)

This study included a 58-year-old female who was incidentally found to have dilatation of the main pancreatic duct during screening health checkup. Despite elevated tumor markers and focal ductal narrowing on magnetic resonance imaging and endoscopic ultrasound, no definite mass was observed and fine-needle aspiration only showed benign glandular tissue. Subsequent serial pancreatic-juice aspiration cytologic examination (SPACE) through an endoscopic nasopancreatic drainage catheter revealed cohesive clusters of atypical ductal cells with enlarged irregular nuclei and mitotic figures, indicating pancreatic adenocarcinoma. The patient underwent radical antegrade modular pancreaticosplenectomy, and a histopathologic review confirmed complete en bloc resection. This study emphasized the diagnostic potential of SPACE in early, non-mass–forming pancreatic cancer, wherein conventional imaging and endoscopic ultrasound-guided biopsy may be inconclusive. Repeated cytologic sampling through an indwelling catheter improves sensitivity while avoiding trans-parenchymal puncture. Although the procedure requires expertise and poses a risk of pancreatitis, it is a valuable adjunctive cytologic approach for confirming malignancy in subtle duct-stricture-only lesions and may contribute to the earlier detection of pancreatic ductal adenocarcinoma.