Enhanced Pancreatic Cytopathology

Cytological samples reported as “insufficient for analysis” 

Over 90% of all adult cancers, including cancers of the pancreas, prostate, and breast, are carcinomas. 
 

Carcinomas develop over a period of years in the very thin (500 micron) epithelial layer that lines our organs.  During this period, the epithelium may develop an area of abnormal cells known as “dysplasia” that contain a limited number of genetic mutations.  Although potentially precancerous, dysplastic cells are still harmless since they don’t yet have the total number of mutations required to be an invasive cancer. If these precancerous cells are detected and treated in time, carcinoma can be prevented before it can actually start. 
 

The epithelium throughout the body is continually being regenerated, with all of the discarded cells, including dysplastic and cancer cells, naturally sloughing off or “exfoliating” into a surrounding body fluid. This fluid can then be sampled to screen for the presence of dysplasia and early cancer. This is how the Pap smear reduced cervical cancer from one of the largest causes of US female cancer death in the 1950’s to the 14th largest by the 1970’s. 
 

The entire ductal epithelium that is the source of over 90% of pancreatic cancer is sloughed off and regenerated every four weeks. All of these discarded epithelial cells are shed into the pancreatic fluid or “juice” that naturally exits the pancreas for the small intestine (duodenum) along with the pancreatic enzymes that are used to help digestion.
 

A sample of pancreatic fluid taken from the area of the duodenum just outside of the pancreas can be readily obtained by a gastroenterologist during a standard, minimally invasive, upper endoscopy. Many of these pancreatic cytology samples, however, will contain less than the minimum threshold of 50 -100 ductal cells typically required for reporting, and will therefore be signed out by the pathologist as “insufficient for analysis”.