Jemaa Yassine, Houissa Fatma, Trabelsi Senda, Moussa Amel, Belhouchet Houda, Mouelhi Leila, Bouraoui Mouna, Bouzaidi Slim, Debbeche Radhouane, Ben Yedder Jamel, Salem Mohamed, Najjar Taoufik
Gastroenterology Department, Charles Nicolle Hospital, Tunis, Tunisia.
Tunis Med. 2008 Apr;86(4):346-9.
Compare the performances of EUS to helical CT in the diagnosis and staging of pancreatic adenocarcinoma.
Forty two consecutive patients (mean age 63 years; 25 men, 17 women) who had surgical exploration and histologically proved pancreatic cancer were retrospectively included. All our patients underwent with endoscopic ultrasonography (EUS) and helical computed tomography (helical CT). Data analysis compared helical CT, EUS with the surgical data with or without histological study in diagnosis, staging and resectability of pancreatic cancer. Surgical findings were used as gold standard.
For positive diagnosis EUS was more sensitive 100% (CI:93-100) than helical CT 88% (CI:77-95). But helical CT was more specific 89% (CI:64-98) than EUS 83% (CI:58-96) for small tumors whose diameter is below 2.5 cm in witch EUS was more sensitive in their detection (100% versus 83%). In evaluating venous involvement EUS was more sensitive than helical CT (96% versus 50%; p<0.05), while CT was more specific (81% versus 75%; p<0.05). Regarding lymph nodes invasion, the two imaging technique had the same sensibility (56%) with better specificity for helical CT (83% versus 75%; p<0.05). The accuracy of EUS in identifying the T and N stages were 80% and 67% respectively, while helical CT have an accuracy of 50% and 71% respectively. EUS and helical CT correctly identified all resectable tumors while EUS was more accurate than helical CT in detecting non resectable tumors 94% versus 69%.
EUS remains superior to helical CT in positive diagnosis of pancreatic adenocarcinoma especially for small tumors and also for the diagnosis of venous invasion and in identifying non resectable tumors. The two techniques have the same accuracy in the detection of lymph node involvement.
比较超声内镜（EUS）与螺旋CT在胰腺腺癌诊断及分期中的表现。
回顾性纳入42例连续接受手术探查且组织学证实为胰腺癌的患者（平均年龄63岁；男性25例，女性17例）。所有患者均接受了内镜超声检查（EUS）和螺旋计算机断层扫描（螺旋CT）。数据分析将螺旋CT、EUS与手术数据进行比较，以评估其在胰腺癌诊断、分期及可切除性判断方面（无论有无组织学研究）的情况。手术结果作为金标准。
在阳性诊断方面，EUS的敏感性更高，为100%（可信区间：93 - 100），而螺旋CT为88%（可信区间：77 - 95）。但对于直径小于2.5 cm的小肿瘤，螺旋CT的特异性更高，为89%（可信区间：64 - 98），而EUS为83%（可信区间：58 - 96），不过EUS对这类小肿瘤的检测更敏感（100%对83%）。在评估静脉受累情况时，EUS比螺旋CT更敏感（96%对50%；p<0.05），而CT的特异性更高（81%对75%；p<0.05）。关于淋巴结侵犯，两种成像技术的敏感性相同（56%），螺旋CT的特异性更好（83%对75%；p<0.05）。EUS识别T期和N期的准确率分别为80%和67%，而螺旋CT的准确率分别为50%和71%。EUS和螺旋CT均能正确识别所有可切除肿瘤，而在检测不可切除肿瘤方面，EUS比螺旋CT更准确，分别为94%和69%。
在胰腺腺癌的阳性诊断中，尤其是对于小肿瘤以及静脉侵犯的诊断和不可切除肿瘤的识别方面，EUS仍优于螺旋CT。两种技术在检测淋巴结受累方面准确率相同。
