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To improve the poor prognosis of pancreatic ductal adenocarcinoma (PDAC), the diagnosis of early-stage PDAC is essential. In particular, the diagnosis of high-grade intraepithelial pancreatic neoplasia/carcinoma in situ (HG-PanIN/CIS) is the best option. However, it is almost impossible to directly observe HG-PanIN/CIS. Thus, identifying a secondary imaging finding due to the disorder is important. Focal pancreatic parenchymal atrophy (FPPA) and hypoechoic area have been reported as preferred secondary signs. We studied 50 patients to clarify the effectiveness of FPPA in diagnosing HG-PanIN/CIS. Most patients had the opportunity to undergo further examination due to the presence of a cyst. Among the 50 patients, 23 (46%) had positive results for serial pancreatic-juice aspiration cytologic examination (SPACE), which has high sensitivity and specificity for diagnosing PADC; 20 of the 23 (87.0%) patients underwent surgery to resect the pancreatic part including the FPPA. Distal pancreatectomy and pancreatoduodenectomy were performed in 19 patients and one patient, respectively. In 13 of the 20 (65%) patients, histopathological examination revealed HG-PanIN/CIS in the pancreatic ductal epithelium of the resected specimens. FPPA could indicate HG-PanIN/CIS, but not satisfactorily. One of the factors for the unsatisfactory results might be the difficulty in identifying FPPA in the pancreatic head area. On the other hand, a pancreatic cyst, especially in the area of FPPA, could lead to the diagnosis of HG-PanIN/CIS. The size of the cyst does not affect the diagnosis of HG-PanIN/CIS.
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2. Yoon SH, Lee JM, Cho JY, et al. Small (≤2 cm) pancreatic adenocarcinoma: analysis of enhancement patters and secondary signs with multiphasic multidetector CT. Radiology. 2011; 259(2): 442-452. DOI: 10.1148/radiol.11101133.
3. Harinck F, Konings ICAW, Kluijt I, et al. A multicenter comparative prospective blinded analysis of EUS and MRI for screening of pancreatic cancer in high-risk individuals. Gut. 2016; 65(9): 1505-1513. DOI: 10.1136/gutjnl-2014-308008.
4. Helmstaedter L, Riemann JF. Pancreatic cancer—EUS and early diagnosis. Langenbeck’s Arch. Surg. 2008; 393(6): 923-927, DOI:10.1007/s00423-007-0275-1.
5. Yasuda I, Iwashita T, Nakashima M, Nakashima M, Moriwaki H. Role of EUS in the early detection of small pancreatic cancer. Dig. Endosc. 2011; 23(s1): 22-25, DOI:10.1111/j.1443-1661.2011.01113.x.
6. Kitano M, Yoshida T, Itonaga M, Tamura T, Hatamaru K, Yamashita Y. Impact of endoscopic ultrasonography on diagnosis of pancreatic cancer. J Gastroenterol. 2019; 54(1): 19-32. DOI: 101007/s00535-018-1519-2.
7. Kawaguchi S, Kikuyama M, Satoh T, Terada S, Kanemoto H, Arai K. Minimally invasive ductal pancreatic carcinoma without low echoic area on endoscopic ultrasound examinations：a case report. J. Jan. Pancreas Soc. 2017; 32(5): 852-858 (In Japanese with English abstract).
8. Iiboshi T, Hanada K, Fukuda T, Yonehara S, Sasaki T, Chayama K. 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. Pancreas. 2012; 41(4): 523-529. DOI: 10.1097/MPA.0b013e31823c0b05.
9. Satoh T, Kikuyama M, Kawaguchi S, Kanemoto H, Muro H, Hanada K. Acute pancreatitis-onset carcinoma in situ of the pancreas with focal fat replacement diagnosed using serial pancreatic-juice aspiration cytologic examination (SPACE). Clin J Gastroenterol. 2017; 10(6): 541-545. DOI: 10.1007/s12328-017-0776-6.
10. Kikuyama M, Hanada K, Ueki T. Pancreatic carcinoma in situ presenting prominent fatty change of the pancreatic body on CT: experiences from 3 cases. J Jpn Pancreas Soc. 2015; 30(4): 626-632. (in Japanese with English abstract).
11. Nakahodo J, Kikuyama M, Nojiri S, et al. Focal parenchymal atrophy of pancreas: An important sign of underlying high-grade pancreatic intraepithelial neoplasia without invasive carcinoma, i.e., carcinoma in situ. Pancreatology. 2020; 20(8): 1689-1697. DOI: 101016/j.pan.2020.09.020.
12. Terada S, Kikuyama M, Kawaguchi S, et al. Proposal for endoscopic ultrasonography classification for small pancreatic cancer. Diagnostics 2019; 9(1): 15. DOI: 10.3390/diagnostics9010015.
13. Kikuyama M, Nakahodo J, Chiba K, et al. Focal pancreatic parenchymal atrophy. Tan to Sui. 2020; 41(11): 1387-1393 (in Japanese).
14. Izumi Y, Hanada K, Okazaki A, et al. Endoscopic ultrasound findings and pathological features of pancreatic carcinoma in situ. Endsco Int Open. 2019; 07(4): E585-E593. DOI: 10.1055/a-0839-4312.
15. Boudreau N, Werb Z, Bissell MJ. Suppression of apoptosis by basement membrane requires three-dimensional tissue organization and withdrawal from the cell cycle. Proc. Natl. Acad. Sci. 1996; 93(8): 3509-3513. DOI: 10.1073/pnas.93.8.3509.
16. Hosoda W, Chianchiano P, Griffin JF, et al. Genetic analysis of isolated high-grade pancreatic intraepithelial neoplasia (HG-PanIN) reveal paucity of alterations in TP53 and SMAD4. J Pathol. 2017; 242(1): 16-23. DOI: 10.1002/path.4884.
17. Tanaka M, Fernandez-del Castillo C, et al. Revision of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 2017; 17(5): 738-753. DOI: 10.1016/j.pan.2017.07.007.
18. Hruban RH, Adsay NV, Albores-Saavedra J, et al. Pancreatic intraepithelial neoplasia – a new nomenclature and classification system for pancreatic ductal lesions. Am J Sur Path. 2001; 25(5): 579-586. DOI: 10.1097/00000478-200105000-00003
19. Yachida S, Jones S, Bozic I, et al. Distant metastasis occurs late during the genetic evolution of pancreatic cancer. Nature 2010; 467 (28): 1114-1117.DOI: 10.1038/nature09515.