Malagò Roberto, D'Onofrio Mirko, Zamboni Giulia A, Faccioli Niccolò, Falconi Massimo, Boninsegna Letizia, Mucelli Roberto Pozzi
Department of Radiology, Policlinico GB Rossi, University of Verona, Verona, Italy.
AJR Am J Roentgenol. 2009 Feb;192(2):424-30. doi: 10.2214/AJR.07.4043.
Diagnosis of malignancy and prognostic assessment continue to be problems in the management of nonfunctioning pancreatic endocrine tumors. Histologic examination is the reference standard. The aim of our study was to compare B-mode and contrast-enhanced sonographic findings regarding nonfunctioning pancreatic endocrine tumors. Signs of malignancy, such as Ki67 index and presence of hepatic metastasis, were considered.
We retrospectively reviewed the cases of 38 consecutively registered patients with nonfunctioning pancreatic endocrine tumors evaluated with B-mode and contrast-enhanced sonography and resected. At contrast-enhanced sonography all lesions were divided into hypovascular lesions and isovascular or hypervascular lesions. On the basis of homogeneity of enhancement, lesions were classified as homogeneous and inhomogeneous. During the late phase of contrast enhancement, all solid focal hypoechoic liver lesions detected at contrast-enhanced sonography were considered hepatic metastatic lesions. Among pathologic data, grading, mitotic index, and Ki67 index were evaluated. Spearman's test was used to compare contrast-enhanced sonographic enhancement pattern with pathologic grade.
In the arterial phase, 24 of 38 nonfunctioning pancreatic endocrine tumors (63.1%) were hypervascular, seven (18.4%) were isovascular, and seven (18.4%) were hypovascular. Positive correlation was found between contrast-enhanced sonographic findings and Ki67 index (r(s) = 0.62; p < 0.0001). The difference between contrast-enhanced and B-mode sonography in the diagnosis of nonfunctioning pancreatic endocrine tumors was statistically significant (p < 0.05). Use of contrast-enhanced sonography increased diagnostic confidence in the detection of hepatic metastasis. The areas under the receiver operating characteristic curves were 0.916 for B-mode sonography and 1.000 for contrast-enhanced sonography (p < 0.05). There was moderate positive correlation between contrast-enhanced sonographic enhancement pattern and the presence of hepatic metastasis at diagnosis (r(s) = 0.46; p = 0.004) and between Ki67 index and the presence of hepatic metastasis (r(s) = 0.48; p = 0.0022).
The contrast-enhanced sonographic enhancement pattern of nonfunctioning pancreatic endocrine tumors has a positive correlation with Ki67 index, which is considered the most reliable independent predictor of the presence of malignancy.
在无功能胰腺内分泌肿瘤的管理中，恶性肿瘤的诊断和预后评估仍然是难题。组织学检查是参考标准。本研究的目的是比较无功能胰腺内分泌肿瘤的B超和超声造影检查结果。考虑了恶性征象，如Ki67指数和肝转移情况。
我们回顾性分析了38例连续登记的无功能胰腺内分泌肿瘤患者的病例，这些患者均接受了B超和超声造影检查并接受了手术切除。在超声造影检查中，所有病变被分为低血供病变和等血供或高血供病变。根据增强的均匀性，病变被分为均匀和不均匀。在超声造影增强的晚期，超声造影检查发现的所有实性局灶性低回声肝脏病变均被视为肝转移病变。在病理数据中，评估了分级、有丝分裂指数和Ki67指数。采用Spearman检验比较超声造影增强模式与病理分级。
在动脉期，38例无功能胰腺内分泌肿瘤中24例（63.1%）为高血供，7例（18.4%）为等血供，7例（18.4%）为低血供。超声造影检查结果与Ki67指数之间存在正相关（r(s)=0.62；p<0.0001）。超声造影和B超在无功能胰腺内分泌肿瘤诊断中的差异具有统计学意义（p<0.05）。超声造影的应用提高了肝转移检测的诊断信心。B超的受试者工作特征曲线下面积为0.916，超声造影为1.000（p<0.05）。超声造影增强模式与诊断时肝转移的存在之间存在中度正相关（r(s)=0.46；p=0.004），Ki67指数与肝转移的存在之间也存在中度正相关（r(s)=0.48；p=0.0022）。
无功能胰腺内分泌肿瘤的超声造影增强模式与Ki67指数呈正相关，Ki67指数被认为是恶性肿瘤存在的最可靠独立预测指标。
