Ahmad N A, Lewis J D, Ginsberg G G, Rosato E F, Morris J B, Kochman M L
Gastroenterology Division, Department of Medicine, Center for Clinical Epidemiology and Biostatistics, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia 19104-4283, USA.
Gastrointest Endosc. 2000 Oct;52(4):463-8. doi: 10.1067/mge.2000.107725.
Endoscopic ultrasound (EUS) is believed to be highly accurate in the local (T) and nodal (N) staging of pancreatic cancer. However, there are scant data concerning the predictive value of EUS for resectability of pancreatic adenocarcinoma. This study was performed to determine the accuracy of TNM staging by EUS in patients with pancreatic adenocarcinoma and to evaluate the role of preoperative TNM staging by EUS for determining resectability in patients with pancreatic adenocarcinoma.
This is a retrospective review of a cohort of 89 patients evaluated preoperatively with EUS for pancreatic adenocarcinoma between January 1995 and December 1997. Preoperative TNM classification by EUS was compared with surgical and histopathologic TNM staging. Resectability rates were determined and compared with the preoperative TNM staging by EUS.
The overall accuracy of EUS for T and N staging was found to be 69% and 54%, respectively. The overall proportion of tumors that were deemed resectable by EUS and were actually found to be resectable during surgical exploration was 46%. The proportion of tumors staged as T4 N1, T4 N0, T3 N1 and T3 N0 by EUS that were found to be resectable during surgical exploration was 45%, 37%, 44% and 62%, respectively.
In a tertiary referral patient population, EUS is not as accurate as previously reported in the T and N staging of pancreatic cancer. EUS is also not predictive of resectability in stage T3 or T4 pancreatic cancer.
内镜超声（EUS）被认为在胰腺癌的局部（T）和淋巴结（N）分期方面具有高度准确性。然而，关于EUS对胰腺腺癌可切除性的预测价值的数据却很少。本研究旨在确定EUS对胰腺腺癌患者进行TNM分期的准确性，并评估术前通过EUS进行TNM分期在确定胰腺腺癌患者可切除性方面的作用。
这是一项对1995年1月至1997年12月期间89例术前接受EUS评估的胰腺腺癌患者队列的回顾性研究。将EUS术前的TNM分类与手术和组织病理学TNM分期进行比较。确定可切除率，并与EUS术前TNM分期进行比较。
发现EUS对T分期和N分期的总体准确率分别为69%和54%。EUS判定为可切除且在手术探查中实际发现可切除的肿瘤总体比例为46%。EUS分期为T4 N1、T4 N0、T3 N1和T3 N0的肿瘤在手术探查中发现可切除的比例分别为45%、37%、44%和62%。
在三级转诊患者群体中，EUS在胰腺癌T和N分期方面不如先前报道的准确。EUS也不能预测T3或T4期胰腺癌的可切除性。
