Dewitt John, Devereaux Benedict M, Lehman Glen A, Sherman Stuart, Imperiale Thomas F
Division of Gastroenterology, Department of Medicine, Indiana University Medical Center, Indianapolis, Indiana, USA.
Clin Gastroenterol Hepatol. 2006 Jun;4(6):717-25; quiz 664. doi: 10.1016/j.cgh.2006.02.020. Epub 2006 May 3.
BACKGROUND & AIMS: It is uncertain whether computed tomography (CT) or endoscopic ultrasound (EUS) is superior for the detection, staging, and resectability of pancreatic cancer. We therefore performed a systematic literature review to determine which test is more accurate.
We identified relevant studies from MEDLINE (1986-2004) and evaluated study quality, which was measured on the basis of guidelines for assessing studies of diagnostic tests. Quantitative outcomes data were abstracted from the studies.
Eleven studies with 678 patients satisfied inclusion criteria. Nine studies assessed tumor detection, all of which concluded that the sensitivity of EUS was superior to CT. Four of 5 studies that assessed tumor staging accuracy and 5 of 8 that assessed nodal staging accuracy concluded that EUS was superior to CT. Among the 4 studies that assessed resectability, 2 showed no difference between EUS and CT, and 1 favored each modality. Three of 11 studies met all but one of the quality criteria. The most important and frequent study limitations were lack of a consecutive series of patients and biased patient selection for surgery. Quantitative comparisons among studies were precluded by differences in tumor staging classifications, surgical selection, CT and EUS techniques, and reporting of operating characteristics.
The published literature comparing EUS and CT for preoperative assessment of pancreatic cancer is heterogeneous in study design, quality, and results. All studies have methodologic limitations that potentially affect validity. Prospective studies with state-of-the-art imaging are needed to further define the role of each test.
对于胰腺癌的检测、分期及可切除性评估，计算机断层扫描（CT）或内镜超声（EUS）哪种方法更具优势尚不确定。因此，我们进行了一项系统文献综述以确定哪种检查更为准确。
我们从MEDLINE（1986 - 2004年）中检索相关研究，并根据诊断试验研究评估指南对研究质量进行评估。从这些研究中提取定量结果数据。
11项研究共678例患者符合纳入标准。9项研究评估了肿瘤检测，所有研究均得出EUS的敏感性优于CT的结论。5项评估肿瘤分期准确性的研究中有4项，8项评估淋巴结分期准确性的研究中有5项得出EUS优于CT的结论。在4项评估可切除性的研究中，2项显示EUS与CT之间无差异，另外1项分别支持两种检查方法。11项研究中有3项几乎符合所有质量标准，但仍有一项未达标准。最重要且最常见的研究局限性是缺乏连续的患者系列以及手术患者选择存在偏差。由于肿瘤分期分类、手术选择、CT和EUS技术以及操作特征报告方面的差异，无法对各研究进行定量比较。
已发表的比较EUS和CT用于胰腺癌术前评估的文献在研究设计、质量和结果方面存在异质性。所有研究均存在可能影响有效性的方法学局限性。需要开展采用先进成像技术的前瞻性研究，以进一步明确每种检查方法的作用。
