内镜超声检查可能在导管内乳头状黏液性肿瘤的术前评估中不是必需的。
Endoscopic ultrasound may be unnecessary in the preoperative evaluation of intraductal papillary mucinous neoplasm.
机构信息
Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
出版信息
HPB (Oxford). 2011 Feb;13(2):112-6. doi: 10.1111/j.1477-2574.2010.00254.x. Epub 2010 Dec 22.
OBJECTIVES
Several imaging modalities are commonly performed during work-up of intraductal papillary mucinous neoplasm (IPMN), but guidelines do not suggest any one technique. The aim of this study was to evaluate tumour and duct measurements by computed tomography (CT) and endoscopic ultrasound (EUS) and their ability to predict high-grade dysplasia (HGD) and cancer within pancreatic IPMN.
METHODS
Patients with IPMN who underwent preoperative CT and EUS between 2001 and 2009 were selected. Data were gathered retrospectively from medical records.
RESULTS
The study group was comprised of 52 patients, 33% (17/52) of whom had HGD or cancer. On fine needle aspirate (FNA), neither carcinoembryonic antigen (CEA) >200 nor cytological analysis correlated with malignancy. In multivariate analysis, duct size ≥ 1.0 cm (P= 0.034) was a significant predictor of HGD or cancer, and diameter on CT scan (P= 0.056) approached significance. Lesion diameter of ≥ 2.5 cm on CT scan identified malignancy in 71% (12/17) of patients (P= 0.037). When analysed, all patients with HGD or cancer had a lesion diameter ≥ 2.5 cm and/or a duct diameter ≥ 1.0 cm by CT scan.
CONCLUSIONS
The use of radiographic criteria on CT including lesion size ≥ 2.5 cm and/or pancreatic duct diameter ≥ 1.0 cm appears to reliably identify patients with either HGD or invasive cancer. High-resolution CT scanning may obviate the need for EUS and FNA in patients with suspected IPMN.
目的
在导管内乳头状黏液性肿瘤（IPMN）的检查中，通常会使用多种影像学方法，但指南并未推荐任何单一技术。本研究旨在评估 CT 和内镜超声（EUS）检查中的肿瘤和胆管测量值，并评估其预测胰腺 IPMN 中高级别异型增生（HGD）和癌症的能力。
方法
选择 2001 年至 2009 年间接受术前 CT 和 EUS 检查的 IPMN 患者。从病历中回顾性收集数据。
结果
研究组包括 52 例患者，其中 33%（17/52）患有 HGD 或癌症。在细针抽吸（FNA）中，癌胚抗原（CEA）>200 或细胞学分析均与恶性肿瘤无关。多变量分析显示，胆管直径≥1.0cm（P=0.034）是 HGD 或癌症的显著预测因子，CT 扫描直径（P=0.056）接近显著。CT 扫描上≥2.5cm 的病变直径可在 71%（12/17）的患者中识别出恶性肿瘤（P=0.037）。分析时，所有患有 HGD 或癌症的患者的 CT 扫描上均有≥2.5cm 的病变直径和/或≥1.0cm 的胰管直径。
结论
CT 上的影像学标准（包括病变大小≥2.5cm 和/或胰管直径≥1.0cm）似乎可以可靠地识别出患有 HGD 或浸润性癌症的患者。高分辨率 CT 扫描可能使怀疑患有 IPMN 的患者无需进行 EUS 和 FNA。
Zotero 插件