Buchs N C, Frossard J L, Rosset A, Chilcott M, Koutny-Fong P, Chassot G, Fasel J H D, Poletti P A, Becker C D, Mentha G, Bühler L, Morel P
Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland.
Swiss Med Wkly. 2007 May 19;137(19-20):286-91. doi: 10.4414/smw.2007.11701.
Current methods for detecting vascular invasion in pancreatic cancer can be inaccurate, invasive, and expensive. The aim of this study is to assess the value of current imaging modalities in determining vascular invasion by pancreatic cancer.
The results of Endoscopic Ultrasonography (EUS), Computed Tomography (CT), Ultrasonography (US), and Angiography performed in 170 patients, suffering from pancreatic cancer, were retrospectively studied and correlated with intra-operative findings and surgical anatomopathological diagnosis after resection. We assessed sensitivity, specificity, positive and negative predictive values, and accuracy for detecting vascular invasion.
EUS turned out to be the most reliable imaging technique for detecting vascular invasion in pancreatic cancer, with a sensitivity of 55%, specificity of 90%, positive predictive value of 61.1%, negative predictive value of 87.5%, and accuracy of 82.2%. CT results were 39.4%, 90%, 52%, 84.4%, and 79.1% for the respective categories, with however, better results with multislice CT. The US results were 3.7% for the sensitivity, 96.3% for the specificity, 25% for the positive predictive value, 75.2% for the negative predictive value, and 73.4% for the accuracy. For angiography, the sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy were 52.6%, 72.3%, 43.5%, 79.1%, and 66.7% respectively.
In this study, EUS was the most valuable imaging modality in assessing vascular invasion (especially for venous invasion) for pancreatic cancer, with an accuracy of more than 80%. A further prospective study should be carried out to evaluate the combination of imaging modalities for the detection of vascular involvement, especially with multi-slice CT which almost reached the performances obtained by EUS.
目前用于检测胰腺癌血管侵犯的方法可能不准确、具有侵入性且成本高昂。本研究的目的是评估当前成像方式在确定胰腺癌血管侵犯方面的价值。
对170例胰腺癌患者进行的内镜超声检查（EUS）、计算机断层扫描（CT）、超声检查（US）和血管造影结果进行回顾性研究，并与手术中的发现以及切除后的手术解剖病理诊断结果进行关联。我们评估了检测血管侵犯的敏感性、特异性、阳性和阴性预测值以及准确性。
EUS被证明是检测胰腺癌血管侵犯最可靠的成像技术，其敏感性为55%，特异性为90%，阳性预测值为61.1%，阴性预测值为87.5%，准确性为82.2%。CT结果在各个类别中分别为39.4%、90%、52%、84.4%和79.1%，不过多层螺旋CT的结果更好。超声检查的敏感性为3.7%，特异性为96.3%，阳性预测值为25%，阴性预测值为75.2%，准确性为73.4%。对于血管造影，敏感性、特异性、阳性预测值、阴性预测值和准确性分别为52.6%、72.3%、43.5%、79.1%和66.7%。
在本研究中，EUS是评估胰腺癌血管侵犯（尤其是静脉侵犯）最有价值的成像方式，准确性超过80%。应进行进一步的前瞻性研究，以评估成像方式联合检测血管受累的情况，特别是多层螺旋CT，其性能几乎达到了EUS的水平。
