Role of the preoperative usefulness of the pathological diagnosis of pancreatic diseases

Pancreatic cancer is the fifth leading cause of cancer death and has the lowest survival rate of any solid cancer.Endoscopic ultrasound-guided fine-needle aspiration biopsy(EUS-FNA) is currently capable of providing a cytopathological diagnosis of pancreatic malignancies with a higher diagnostic power,with a sensitivity and specificity of 85%-89% and 98%-99%,compared to pancreatic juice cytology(PJC),whose sensitivity and specificity are only 33.3%-93% and 83.3%-100%.However,EUS-FNA is not effective in the cases of carcinoma in situ and minimally invasive carcinoma because both are undetectable by endoscopic ultrasonography,although PJC is able to detect them.As for the frequency of complications such as post endoscopic retrograde cholangiopancreatography pancreatitis,EUS-FNA is safer than PJC.To diagnose pancreatic cancer appropriately,it is necessary for us to master both procedures so that we can select the best methods of sampling tissues while considering the patient's safety and condition.

Review on acute pancreatitis attributed to COVID-19 infection

The coronavirus disease 2019(COVID-19)is known to cause gastrointestinal symptoms.Recent studies have revealed COVID-19-attributed acute pancreatitis(AP).However,clinical characteristics of COVID-19-attributed AP remain unclear.We performed a narrative review to elucidate relation between COVID-19 and AP using the PubMed database.Some basic and pathological reports revealed expression of angiotensin-converting enzyme 2 and transmembrane protease serine 2,key proteins that aid in the entry of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)into the pancreas.The experimental and pathological evaluation suggested that SARS-CoV-2 infects human endocrine and exocrine pancreas cells,and thus,SARS-CoV-2 may have a direct involvement in pancreatic disorders.Additionally,systemic inflammation,especially in children,may cause AP.Levels of immune mediators associated with AP,including interleukin(IL)-1β,IL-10,interferon-γ,monocyte chemotactic protein 1,and tumor necrosis factor-αare higher in the plasma of patients with COVID-19,that suggests an indirect involvement of the pancreas.In real-world settings,some clinical features of AP complicate COVID-19,such as a high complication rate of pancreatic necrosis,severe AP,and high mortality.However,clinical features of COVID-19-attributed AP remain uncertain due to insufficient research on etiologies of AP.Therefore,high-quality clinical studies and case reports that specify methods for differential diagnoses of other etiologies of AP are needed.

Endoscopic ultrasound-guided fine-needle aspiration biopsy-Recent topics and technical tips

Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) is a useful procedure that enables reliable pathological diagnoses of pancreatobiliary diseases, subepithelial lesions, and swollen lymph nodes. In recent years, a pathological diagnosis based on EUS-FNA has made it possible to provide accurate treatment methods not only in these fields, but also in respiratory organs and otorhinolaryngology. This review discusses the latest topics pertaining to EUS-FNA as well as procedural tips.