超声内镜引导下非钙化性慢性胰腺炎的组织病理学相关性：一项前瞻性组织特征研究。

Histopathologic correlates of noncalcific chronic pancreatitis by EUS: a prospective tissue characterization study.

作者信息

Varadarajulu Shyam, Eltoum Isam, Tamhane Ashutosh, Eloubeidi Mohamad A

机构信息

Division of Gastroenterology-Hepatology, Department of Pathology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35294, USA.

出版信息

Gastrointest Endosc. 2007 Sep;66(3):501-9. doi: 10.1016/j.gie.2006.12.043. Epub 2007 Jul 20.

DOI:10.1016/j.gie.2006.12.043

PMID:17640639

Abstract

BACKGROUND

Studies that correlated EUS features of chronic pancreatitis (CP) with histopathology are retrospective and only include patients with severe disease or calcific pancreatitis. Controversies regarding the significance of EUS features of noncalcific CP (NCCP) remain unresolved.

OBJECTIVE

To correlate EUS criteria for NCCP with histology from surgical specimens.

DESIGN

Prospective study.

SETTING

Tertiary referral center.

PATIENTS

All patients who underwent EUS for pancreaticobiliary indications and subsequent pancreatic surgery. Patients with calcific pancreatitis were excluded.

METHODS

Individual CP features on EUS were carefully documented with relation to different parts of the pancreas. Standard EUS criteria for CP were adopted. All patients underwent surgery within 2 months of EUS. A single pathologist blinded to EUS findings reviewed the specimens and graded fibrosis (total score, 12; >or=6=unequivocal CP). A quantitative receiver operating characteristic (ROC) curve analysis was performed, and Spearman rank correlation coefficients were calculated.

MAIN OUTCOME MEASUREMENTS

Correlate EUS criteria for NCCP, with histology from surgical specimens.

RESULTS

Of the 42 patients evaluated, NCCP was diagnosed histologically in 21 patients (50%). None of the patients had CP diagnosis by CT. ROC curve analysis revealed that 4 or more EUS criteria provided the best sensitivity (90.5%), specificity (85.7%), and accuracy (88.1%) for diagnosing NCCP. Parenchymal EUS features that were significantly associated with histopathologic NCCP were foci (P<.0001), stranding (P<.001), and lobulations (P=.04); ductal features that were significantly associated with histopathologic NCCP were dilated (P<.0001) or irregular main pancreatic duct (P<.0001), side branches (P<.001), and hyperechoic duct margins (P=.03). There was a significant correlation between the number of EUS criteria and severity of NCCP on histology (r=0.85; P<.0001).

LIMITATIONS

Small number of patients.

CONCLUSIONS

An excellent correlation exists between EUS and histologic findings of NCCP.

摘要

背景

将慢性胰腺炎（CP）的内镜超声（EUS）特征与组织病理学相关联的研究均为回顾性研究，且仅纳入了重症疾病或钙化性胰腺炎患者。关于非钙化性CP（NCCP）的EUS特征的意义仍存在争议。

目的

将NCCP的EUS标准与手术标本的组织学结果相关联。

设计

前瞻性研究。

地点

三级转诊中心。

患者

所有因胰胆疾病接受EUS检查并随后接受胰腺手术的患者。排除钙化性胰腺炎患者。

方法

仔细记录EUS上与胰腺不同部位相关的个体CP特征。采用CP的标准EUS标准。所有患者在EUS检查后2个月内接受手术。一名对EUS检查结果不知情的病理学家对标本进行检查并对纤维化进行分级（总分12分；≥6分=明确的CP）。进行定量接受者操作特征（ROC）曲线分析，并计算Spearman等级相关系数。

主要观察指标

将NCCP的EUS标准与手术标本的组织学结果相关联。

结果

在评估的42例患者中，21例（50%）经组织学诊断为NCCP。所有患者均未通过CT诊断为CP。ROC曲线分析显示，4项或更多EUS标准对诊断NCCP具有最佳的敏感性（90.5%）、特异性（85.7%）和准确性（88.1%）。与组织病理学NCCP显著相关的实质EUS特征为病灶（P<0.0001）、条索状（P<0.001）和分叶（P=0.04）；与组织病理学NCCP显著相关的导管特征为扩张（P<0.0001）或不规则的主胰管（P<0.0001）、侧支（P<0.001）和高回声导管边缘（P=0.03）。EUS标准数量与组织学上NCCP的严重程度之间存在显著相关性（r=0.85；P<0.0001）。