Shi Xiuhua, Sun Qingfang, Bian Liuguan, Zhao Weiguo, Shen Jiankang, Wang Weiqing, Ning Guang
Department of Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
Neuro Endocrinol Lett. 2011;32(6):865-73.
Bilateral inferior petrosal sinus sampling (BIPSS), currently, is the gold standard test for the differential diagnosis of Cushing's syndrome (CS), but few data are available on the efficacy and accuracy of BIPSS in the qualitative diagnosis of ACTH-dependent CS and lateralization of Cushing's disease (CD); especially, the evaluation of BIPSS in all CD patients with transsphenoidal surgery (TSS). As a result, we investigated whether such invasive test compared other noninvasive tests may affect the efficacy and accuracy of diagnosis and TSS treatment in ACTH-dependent CS.
We investigated the efficacy and lateralized accuracy of diagnostic and therapeutic of BIPSS in ACTH-dependent CS.
A retrospective analysis was conducted at a single care center in Ruijin Hospital, Shanghai City.
CD was confirmed by histopathology in one hundred and nineteen patients, include sixty-four patients with BIPSS procedure; and ectopic ACTH syndrome (EAS) also was histological confirmed in five patients. MAIN INTERVENTIONS AND OUTCOMES: Sixty-nine patients were all administrated with BIPSS test. Additionally, other noninvasive tests included endocrine examinations, low and high dose dexamethasone suppression test (LDDST and HDDST); imagine examinations include magnetic resonance imaging (MRI) and positron emission tomography and computerized tomography (PET-CT).Gradients of inferior petrosal sinus (IPS) to peripheral (IPS/P) ACTH were calculated before and after BIPSS procedure completed five minutes.
In patients with proven pituitary cases, stringent response criteria in MRI and HDDST testing were fully by 51.6% and 60.3% respectively. While BIPSS, gave direct evidence of CD in 90.6% of these cases. The sensitivity for a basal IPS/P gradient greater than 2 was 89.1%, with 100% specificity and a diagnostic accuracy of 87.5%. A subgroup of 14 patients (all were CD) had contradictory responses to routine test with HDDST; while the sensitivity, specificity and accuracy of BIPSS were 100% respectively. Compared with the MRI and DST, we accepted Receiver Operating Characteristic (ROC) curve analysis showed that BIPSS performance is the best efficacy diagnosis tool in CS. In total, 57 of 64 patients with CD had an IPS/P gradient greater than 2, resulting in the sensitivity, specificity and diagnostic accuracy are 90.5%, 100%, 95.2% respectively. Additionally, the accuracy value of BIPSS in indicating dominant side should also be stressed in adenoma lateralization of CD. Finally, BIPSS test contributed most in the remission efficacy of TSS; then remission rate of underwent BIPSS group is 92.2% compared to the rate of 80% in without BIPSS group (p<0.01), Compared with other noninvasive tests, turn out the highest accuracy rate in remission.
The application of BIPSS is associated with efficacy and accuracy of ACTH-dependent CS and lateralization of CD, what's more, all above, we can conclude that BIPSS is associated with the surgical therapy in CD patients. Therefore, BIPSS dedicate to the diagnosis, treatment and intraoperation administration of ACTH-dependent CS.
目前，双侧岩下窦采血（BIPSS）是库欣综合征（CS）鉴别诊断的金标准检查，但关于BIPSS在促肾上腺皮质激素（ACTH）依赖性CS定性诊断及库欣病（CD）定位诊断中的有效性和准确性的数据较少；尤其是对所有接受经蝶窦手术（TSS）的CD患者进行BIPSS评估。因此，我们研究了这种侵入性检查与其他非侵入性检查相比是否会影响ACTH依赖性CS的诊断有效性、准确性及TSS治疗效果。
我们研究了BIPSS在ACTH依赖性CS诊断和治疗中的有效性及定位准确性。
在上海市瑞金医院的一个护理中心进行回顾性分析。
119例患者经组织病理学确诊为CD，其中64例患者接受了BIPSS检查；5例患者经组织学确诊为异位ACTH综合征（EAS）。主要干预措施和结果：69例患者均接受了BIPSS检查。此外，其他非侵入性检查包括内分泌检查、低剂量和高剂量地塞米松抑制试验（LDDST和HDDST）；影像学检查包括磁共振成像（MRI）和正电子发射断层扫描及计算机断层扫描（PET-CT）。在BIPSS检查完成5分钟前后计算岩下窦（IPS）与外周血（IPS/P）ACTH的梯度。
在确诊为垂体病例的患者中，MRI和HDDST检测中严格的反应标准分别达到51.6%和60.3%。而BIPSS在这些病例中90.6%的患者中给出了CD的直接证据。基础IPS/P梯度大于2时的敏感性为89.1%，特异性为100%，诊断准确性为87.5%。14例患者（均为CD）的亚组对HDDST常规检查有矛盾反应；而BIPSS的敏感性、特异性和准确性分别为100%。与MRI和DST相比，我们采用受试者操作特征（ROC）曲线分析表明BIPSS在CS中是诊断有效性最佳的工具。总共64例CD患者中有57例IPS/P梯度大于2，敏感性、特异性和诊断准确性分别为90.5%、100%、95.2%。此外，在CD腺瘤定位中，BIPSS在指示优势侧的准确性方面也应得到强调。最后，BIPSS检查在TSS缓解疗效中贡献最大；接受BIPSS组的缓解率为92.2%，而未接受BIPSS组的缓解率为80%（p<0.01），与其他非侵入性检查相比，缓解准确率最高。
BIPSS的应用与ACTH依赖性CS的有效性、准确性及CD的定位相关，此外，我们可以得出结论，BIPSS与CD患者的手术治疗相关。因此，BIPSS致力于ACTH依赖性CS的诊断、治疗及术中管理。
