超声内镜诊断胰腺癌血管侵犯：手术及组织学相关性

EUS diagnosis of vascular invasion in pancreatic cancer: surgical and histologic correlates.

作者信息

Aslanian Harry, Salem Ronald, Lee Jeffrey, Andersen Dana, Robert Marie, Topazian Mark

机构信息

Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.

出版信息

Am J Gastroenterol. 2005 Jun;100(6):1381-5. doi: 10.1111/j.1572-0241.2005.41675.x.

DOI:10.1111/j.1572-0241.2005.41675.x

PMID:15929774

Abstract

BACKGROUND

Endoscopic ultrasound (EUS) has been compared to intraoperative surgical palpation for diagnosis of vascular invasion by pancreatic cancer. This study compares EUS with vascular resection and histologic evidence of vascular invasion in resected pancreatic masses.

METHODS

All patients with solid pancreatic masses who underwent both preoperative EUS and surgery at 1 hospital over a 7 year period were identified. The relationship of pancreatic masses to adjacent vessels was prospectively assessed by EUS. EUS findings were compared to surgical and pathology gold standards. "Vascular adherence" was defined as tumor adherence requiring vascular resection during surgery, and "vascular invasion" as histologic invasion of vessel wall by tumor.

RESULTS

30 of 68 patients were resectable. Among these 30, vascular adherence was present in 8, including 18% of patients with an intact echoplane between tumor and adjacent vessels at EUS, 29% of those with loss of echoplane alone, and 50% of those with additional EUS features of vascular involvement. Vascular invasion was present in 4, including 12% of patients with an intact echoplane, 0% of those with loss of echoplane alone, and 33% of those with additional EUS features. Sensitivity, specificity, PPV, and NPV of EUS were 63%, 64%, 43% and 80% for vascular adherence and 50% 58%, 28% and 82% for vascular invasion. NPV rose to 90% for vascular adherence if only the portal confluence vessels were considered.

CONCLUSIONS

EUS has poor sensitivity, specificity, and positive predictive value for diagnosis of venous involvement by pancreatic cancer.

摘要

背景

内镜超声（EUS）已被用于与术中手术触诊相比较，以诊断胰腺癌的血管侵犯情况。本研究将EUS与切除的胰腺肿块的血管切除及血管侵犯的组织学证据进行比较。

方法

确定在7年期间于1家医院接受术前EUS和手术的所有实性胰腺肿块患者。通过EUS前瞻性评估胰腺肿块与相邻血管的关系。将EUS检查结果与手术和病理金标准进行比较。“血管粘连”定义为手术期间需要进行血管切除的肿瘤粘连，“血管侵犯”定义为肿瘤对血管壁的组织学侵犯。

结果

68例患者中有30例可切除。在这30例中，8例存在血管粘连，其中EUS显示肿瘤与相邻血管之间有完整回声平面的患者占18%，仅有回声平面消失的患者占29%，具有其他EUS血管受累特征的患者占50%。4例存在血管侵犯，其中有完整回声平面的患者占12%，仅有回声平面消失的患者占0%，具有其他EUS特征的患者占33%。EUS对血管粘连的敏感性、特异性、阳性预测值和阴性预测值分别为63%、64%、43%和80%，对血管侵犯的分别为50%、58%、28%和82%。如果仅考虑门静脉汇合血管，血管粘连的阴性预测值升至90%。