Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
Gastrointest Endosc. 2010 Feb;71(2):249-55. doi: 10.1016/j.gie.2009.08.023. Epub 2009 Nov 17.
Despite advances in imaging, differentiating benign from malignant causes of pancreatic duct dilation is difficult.
The aim of our study was to assess the accuracy of the periductal hypoechoic sign (PHS), defined as patchy hypoechoic areas adjacent to a dilated pancreatic duct, for the diagnosis of pancreatic malignancy.
Single-center, retrospective analysis.
Tertiary care university hospital.
All patients who underwent EUS from 2006 to 2008 for evaluation of pancreatic pathology were identified. Those with pancreatic duct dilation of 4 mm or more in the head of the pancreas or 3 mm or more in the body or tail were included. Digitally recorded EUS images were analyzed for PHS by 1 endoscopist blinded to final results. The final diagnosis was based on pathology results or clinical follow-up.
During the study period, 84 of 427 patients who underwent EUS for pancreas pathology had dilated pancreatic ducts. Of these, 42 patients had benign disease and 42 had pancreatic malignancy. The PHS was noted in 31 (73.8%) of 42 patients with malignancy compared with 6 (14.3%) of 42 patients with benign disease (P < .001). The PHS had a sensitivity of 73.8%, a specificity of 85.7%, and an accuracy of 79.8% for the diagnosis of pancreatic malignancy. After adjusting for age, patients with the PHS were 17 times more likely to have a malignancy (odds ratio 16.66; 95% CI, 5.01-55.44). Pancreatic duct diameter or dilation of both bile and pancreatic ducts were not predictive of malignancy.
A retrospective design.
The PHS was an accurate and independent predictor of pancreatic malignancy in patients with a dilated pancreatic duct.
尽管影像学技术不断进步，但是区分胰腺管扩张的良恶性病因仍然具有挑战性。
本研究旨在评估胰腺管周围低回声征（PHS）对胰腺恶性肿瘤的诊断准确性，该征象定义为胰腺管扩张部位周围的局灶性低回声区域。
单中心、回顾性分析。
三级保健大学医院。
所有于 2006 年至 2008 年因胰腺病变接受 EUS 检查的患者均被识别。纳入标准为胰头部胰管扩张≥4mm 或体尾部胰管扩张≥3mm。由 1 名内镜医师对胰腺管周围低回声征进行盲法分析，该医师不知道最终结果。最终诊断基于病理结果或临床随访。
在研究期间，84 例因胰腺病变而行 EUS 检查的患者中，胰管扩张 42 例。其中，良性疾病 42 例，恶性肿瘤 42 例。恶性肿瘤组中 31 例（73.8%）存在胰腺管周围低回声征，而良性疾病组中 6 例（14.3%）存在胰腺管周围低回声征（P＜0.001）。胰腺管周围低回声征诊断胰腺恶性肿瘤的敏感性为 73.8%，特异性为 85.7%，准确性为 79.8%。校正年龄后，存在胰腺管周围低回声征的患者发生恶性肿瘤的可能性增加 17 倍（优势比 16.66；95%CI，5.01-55.44）。胰管直径或同时扩张的胆管和胰管均不能预测恶性肿瘤。
回顾性设计。
在胰腺管扩张的患者中，胰腺管周围低回声征是一种准确且独立的胰腺恶性肿瘤预测指标。
