Soriano Antonio, Castells Antoni, Ayuso Carmen, Ayuso Juan Ramón, de Caralt Maria Teresa, Ginès Maria Angels, Real Maria Isabel, Gilabert Rosa, Quintó Llorenç, Trilla Antoni, Feu Faust, Montanyà Xavier, Fernández-Cruz Laureano, Navarro Salvador
Department of Gastroenterology, Institut de Malalties Digestives, University of Barcelona, Barcelona, Catalonia, Spain.
Am J Gastroenterol. 2004 Mar;99(3):492-501. doi: 10.1111/j.1572-0241.2004.04087.x.
The objective of this study was to evaluate prospectively the efficacy of different strategies based on endoscopic ultrasonography (EUS), helical computed tomography (CT), magnetic resonance imaging (MRI), and angiography (A) in the staging and tumor resectability assessment of pancreatic cancer.
All consecutive patients with pancreatic carcinoma judged fit for laparotomy were studied by EUS, CT, MRI, and A. Results of each of the imaging techniques regarding primary tumor, locoregional extension, lymph-node involvement, vascular invasion, distant metastases, tumor TNM stage, and tumor resectability were compared with the surgical findings. Univariate, logistic regression, decision, and cost minimization analyses were performed.
Sixty-two patients with pancreatic cancer were included. Helical CT had the highest accuracy in assessing extent of primary tumor (73%), locoregional extension (74%), vascular invasion (83%), distant metastases (88%), tumor TNM stage (46%), and tumor resectability (83%), whereas EUS had the highest accuracy in assessing tumor size (r = 0.85) and lymph node involvement (65%). The decision analysis demonstrated that the best strategy to assess tumor resectability was based on CT or EUS as initial test, followed by the alternative technique in those potentially resectable cases. Cost minimization analysis favored the sequential strategy in which EUS was used as a confirmatory technique in those patients in whom helical CT suggested resectability of the tumor.
Helical CT and EUS are the most useful individual imaging techniques in the staging of pancreatic cancer. In those cases with potentially resectable tumors a sequential approach consisting of helical CT as an initial test and EUS as a confirmatory technique seems to be the most reliable and cost minimization strategy.
本研究的目的是前瞻性评估基于内镜超声检查（EUS）、螺旋计算机断层扫描（CT）、磁共振成像（MRI）和血管造影（A）的不同策略在胰腺癌分期及肿瘤可切除性评估中的疗效。
对所有判定适合剖腹手术的连续性胰腺癌患者进行EUS、CT、MRI和A检查。将每种成像技术关于原发肿瘤、局部区域扩展、淋巴结受累、血管侵犯、远处转移、肿瘤TNM分期和肿瘤可切除性的结果与手术 findings进行比较。进行单因素分析、逻辑回归分析、决策分析和成本最小化分析。
纳入62例胰腺癌患者。螺旋CT在评估原发肿瘤范围（73%）、局部区域扩展（74%）、血管侵犯（83%）、远处转移（88%）、肿瘤TNM分期（46%）和肿瘤可切除性（83%）方面准确性最高，而EUS在评估肿瘤大小（r = 0.85）和淋巴结受累（65%）方面准确性最高。决策分析表明，评估肿瘤可切除性的最佳策略是以CT或EUS作为初始检查，然后对那些可能可切除的病例采用替代技术。成本最小化分析支持序贯策略，即在螺旋CT提示肿瘤可切除的患者中，将EUS用作确认技术。
螺旋CT和EUS是胰腺癌分期中最有用的单项成像技术。在那些肿瘤可能可切除的病例中，由螺旋CT作为初始检查和EUS作为确认技术组成的序贯方法似乎是最可靠且成本最小化的策略。
