Queneau P E, Sauvé G, Koch S, Thibault P, Cléau D, Heyd B, Mantion G, Carayon P
Gastroenterology Unit and Digestive and Vascular Surgery Unit, University Hospital of Besançon, Besançon Cedex, France.
JOP. 2001 May;2(3):98-104.
Endoscopic ultrasonography is considered a highly accurate procedure for diagnosing small pancreatic tumors and assessing their locoregional extension.
To evaluate the impact of endoscopic ultrasonography on the management of pancreatic adenocarcinoma in clinical practice.
Sixty-four consecutive patients (mean age 70.5 plus/minus 11.9 years) hospitalized for staging or diagnosis of pancreatic adenocarcinoma were retrospectively (from January 1995 to November 1997) or prospectively studied (from December 1997 to August 1999).
Group 1 consisted of 52 patients with pancreatic adenocarcinoma which was discovered using computerized tomography scanning and/or ultrasound. Endoscopic ultrasonography was utilized for staging purposes only in patients who were considered to be operable and the tumor to be resectable based on computerized tomography scanning criteria. Group 2 consisted of 12 patients who were diagnosed as having a pancreatic adenocarcinoma using endoscopic ultrasonography whereas computerized tomography scanning and ultrasound was negative.
The impact of endoscopic ultrasonography was analyzed on the basis of the number of patients requiring endoscopic ultrasonography as a staging procedure (Group 1) and by evaluating the performance of endoscopic ultrasonography in determining resectability (Groups 1 and 2) based on the surgical and anatomopathological results.
Endoscopic ultrasonography was performed in 20 out of 64 patients (31.3%): 8/52 in Group 1 (15.4%) and all 12 patients of Group 2. Endoscopic ultrasonography correctly assessed an absolute contraindication to resection in 11 cases. Resection was confirmed in 8 of the 9 cases selected by endoscopic ultrasonography. The positive predictive value, negative predictive value and overall accuracy of endoscopic ultrasonography for determining resection were 89%, 100%, and 95%, respectively.
The impact of endoscopic ultrasonography seems especially relevant for the detection of pancreatic tumors after negative computerized tomography scanning, and for the prevention of unnecessary laparotomies as complementary staging after ultrasonography and computerized tomography scanning.
内镜超声检查被认为是诊断小胰腺肿瘤及其局部区域扩展的一种高度准确的方法。
评估内镜超声检查在临床实践中对胰腺腺癌治疗的影响。
对连续64例（平均年龄70.5±11.9岁）因胰腺腺癌分期或诊断而住院的患者进行回顾性研究（1995年1月至1997年11月）或前瞻性研究（1997年12月至1999年8月）。
第1组由52例通过计算机断层扫描和/或超声发现胰腺腺癌的患者组成。仅对根据计算机断层扫描标准被认为可手术且肿瘤可切除的患者使用内镜超声检查进行分期。第2组由12例经内镜超声检查诊断为胰腺腺癌而计算机断层扫描和超声检查为阴性的患者组成。
根据作为分期程序需要内镜超声检查的患者数量（第1组），并通过基于手术和解剖病理学结果评估内镜超声检查在确定可切除性方面的性能（第1组和第2组），分析内镜超声检查的影响。
64例患者中有20例（31.3%）进行了内镜超声检查：第1组中的8/52例（15.4%）和第2组的所有12例患者。内镜超声检查正确评估了11例绝对手术禁忌证。内镜超声检查选择的9例中有8例确认可手术切除。内镜超声检查确定手术切除的阳性预测值、阴性预测值和总体准确性分别为89%、100%和95%。
内镜超声检查的影响似乎尤其与计算机断层扫描阴性后胰腺肿瘤的检测相关，以及作为超声检查和计算机断层扫描后的补充分期用于预防不必要的剖腹手术。
