Immunocytochemical detection of p53 protein from pancreatic duct brushings in patients with pancreatic carcinoma.

BACKGROUND: It is often difficult to distinguish pancreatic carcinoma preoperatively from chronic pancreatitis. Therefore, we have developed a new method of detecting p53 immunoreactivity in cytologic material obtained by endoscopic retrograde pancreatic duct brushing (ERPDB).

METHODS: Twenty-eight patients with prominent strictures of the main pancreatic duct demonstrated by pancreatography including 20 ductal cell carcinoma and 8 chronic pancreatitis were studied. The ability to distinguish between these two groups preoperatively by conventional cytologic examination was compared with p53 immunocytochemistry using ERPDB:

RESULTS: The sensitivity, specificity, and overall accuracy of conventional cytologic examination in distinguishing ductal cell carcinoma from chronic pancreatitis were 60%, 100%, and 71% respectively. In comparison, the sensitivity, specificity, and overall accuracy of p53 immunocytochemistry in distinguishing were 90%, 100%, and 93%, respectively. The sensitivity of p53 staining of specimens from patients with carcinoma of the body or tail of the pancreas (90%) was the same for those with tumors of the head of the pancreas (90%).

CONCLUSIONS: These results suggest that p53 immunocytochemistry using ERPDB in conjunction with conventional cytologic examination can help differentiate ductal cell carcinoma from chronic pancreatitis preoperatively.