Varadarajulu Shyam, Wallace Michael B
Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina, USA.
Cancer Control. 2004 Jan-Feb;11(1):15-22. doi: 10.1177/107327480401100103.
Accurate staging of pancreatic cancer is essential for surgical planning and for identification of locally advanced and metastatic disease that is incurable by surgery. Advances in endoscopic sonography (EUS), computed tomography (CT), and positron emission tomography have improved the accuracy of staging and reduced the number of incomplete surgical resections. Tissue acquisition is necessary in nonsurgical cases when chemoradiotherapy is considered. The complex regional anatomy of the pancreas makes cytologic diagnosis of malignancy at this region difficult without exploratory surgery. Although CT-guided fine-needle aspiration (FNA) is used for this purpose, reports of an increased risk of peritoneal dissemination of cancer cells and a false-negative rate of nearly 20% make this a poor choice. The ability to position the EUS-transducer in direct proximity to the pancreas by means of the stomach and duodenum, combined with the use of FNA, increases the specificity of EUS in detecting pancreatic malignancies.
The current literature regarding the accuracy of EUS with FNA in the evaluation of pancreatic cancer is reviewed.
EUS accuracy ranges from 78% to 94% for tumor staging and from 64% to 82% for nodal staging. EUS also enables FNA of lesions that are too small to be identified by CT or MRI or too well encased by surrounding vascular structures to safely allow percutaneous biopsy. The accuracy for detecting invasion into the superior mesenteric artery and vein is lower than that for detecting portal or splenic vein invasion, especially for large tumors. EUS permits delivery of localized therapy such as celiac plexus neurolysis for pain control and direct intra-lesional injection of antitumor therapy.
EUS in combination with FNA is a highly accurate method of preoperative staging of pancreatic cancer, especially those too small to be characterized by CT or MRI, and it has the ability to obtain cytological confirmation of pancreatic cancer.
准确的胰腺癌分期对于手术规划以及识别无法通过手术治愈的局部晚期和转移性疾病至关重要。内镜超声检查（EUS）、计算机断层扫描（CT）和正电子发射断层扫描技术的进步提高了分期的准确性，并减少了不完全手术切除的数量。在考虑进行放化疗的非手术病例中，获取组织是必要的。胰腺复杂的区域解剖结构使得在没有 exploratory 手术的情况下，对该区域的恶性肿瘤进行细胞学诊断变得困难。尽管 CT 引导下细针穿刺抽吸活检（FNA）用于此目的，但有报道称癌细胞腹膜播散风险增加且假阴性率接近 20%，这使其成为一个不佳的选择。通过胃和十二指肠将 EUS 换能器直接置于胰腺附近的能力，结合 FNA 的使用，提高了 EUS 在检测胰腺恶性肿瘤方面的特异性。
回顾了当前关于 EUS 联合 FNA 在评估胰腺癌准确性方面的文献。
EUS 在肿瘤分期方面的准确性范围为 78%至 94%，在淋巴结分期方面为 64%至 82%。EUS 还能够对太小而无法通过 CT 或 MRI 识别或被周围血管结构包裹过紧而无法安全进行经皮活检的病变进行 FNA。检测侵犯肠系膜上动脉和静脉的准确性低于检测门静脉或脾静脉侵犯的准确性，尤其是对于大肿瘤。EUS 允许进行局部治疗，如腹腔神经丛阻滞以控制疼痛和直接瘤内注射抗肿瘤治疗。
EUS 联合 FNA 是一种高度准确的胰腺癌术前分期方法，特别是对于那些太小而无法通过 CT 或 MRI 表征的肿瘤，并且它有能力获得胰腺癌的细胞学确诊。
