Song Moon Hee, Lee Sung Koo, Kim Myung-Hwan, Lee Hyun Ju, Kim Kyu-Pyo, Kim Hyun Jun, Lee Sang Soo, Seo Dong Wan, Min Young Il
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea.
Gastrointest Endosc. 2003 Jun;57(7):891-6. doi: 10.1016/s0016-5107(03)70026-1.
The differential diagnosis in pancreatic cystic lesions is often difficult despite the availability of various modern imaging modalities. This study assessed the role of EUS in the following: (1) discrimination of pseudocysts from pancreatic cystic tumors, (2) differential diagnosis between serous cystadenoma and mucinous cystic tumor, and (3) prediction of accompanying malignancy in intraductal papillary mucinous tumor.
EUS findings in 75 patients with pancreatic cystic lesions (58 cystic tumors, 17 pseudocysts) were evaluated. In the comparison of pseudocysts and cystic tumors, the latter included intraductal papillary mucinous tumor, mucinous cystic tumors, and serous cystadenomas, but not solid-pseudopapillary tumors.
In univariate analysis, pseudocysts exhibited echogenic debris and parenchymal changes more often than cystic tumors did (respectively, 29% vs. 6%, p < 0.05; and 65% vs. 4%, p < 0.001). In contrast, septa and mural nodules were found more frequently in cystic tumors than pseudocysts (respectively, 69% vs. 12%, p < 0.001; 56% vs. 12%, p < 0.01). Multivariate analysis revealed that parenchymal changes (odds ratio [OR] = 83.59; p < 0.01); septa (OR = 30.75; p < 0.05); and mural nodules (OR = 21.38; p < 0.05) were independent predictors of differentiation between pseudocysts and cystic tumors. Serous cystadenoma exhibited diverse EUS features, as well as a honeycomb appearance. Mural nodules were found more often in mucinous cystic tumors than in serous cystadenomas (p < 0.05). There were no factors that predicted malignancy in intraductal papillary mucinous tumor.
EUS is a useful complementary imaging method for differentiation of pancreatic cystic lesions.
尽管有各种现代成像方式，但胰腺囊性病变的鉴别诊断往往很困难。本研究评估了超声内镜（EUS）在以下方面的作用：（1）区分假性囊肿与胰腺囊性肿瘤；（2）浆液性囊腺瘤与黏液性囊性肿瘤的鉴别诊断；（3）导管内乳头状黏液性肿瘤伴发恶性肿瘤的预测。
评估了75例胰腺囊性病变患者（58例囊性肿瘤，17例假性囊肿）的EUS检查结果。在假性囊肿与囊性肿瘤的比较中，后者包括导管内乳头状黏液性肿瘤、黏液性囊性肿瘤和浆液性囊腺瘤，但不包括实性假乳头状肿瘤。
单因素分析显示，假性囊肿比囊性肿瘤更常出现回声性碎屑和实质改变（分别为29%对6%，p<0.05；65%对4%，p<0.001）。相反，囊性肿瘤中发现间隔和壁结节比假性囊肿更频繁（分别为69%对12%，p<0.001；56%对12%，p<0.01）。多因素分析显示，实质改变（优势比[OR]=83.59；p<0.01）、间隔（OR=30.75；p<0.05）和壁结节（OR=21.38；p<0.05）是假性囊肿与囊性肿瘤鉴别的独立预测因素。浆液性囊腺瘤表现出多样的EUS特征以及蜂窝状外观。黏液性囊性肿瘤中发现壁结节比浆液性囊腺瘤更频繁（p<0.05）。没有因素可预测导管内乳头状黏液性肿瘤的恶性程度。
EUS是胰腺囊性病变鉴别诊断的一种有用的补充成像方法。
