Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St Louis, MO, USA.
Pancreas. 2012 Jul;41(5):767-72. doi: 10.1097/MPA.0b013e31823ba536.
"Double-duct sign" (strictures in both common bile duct [CBD] and pancreatic duct [PD] with proximal dilation) on endoscopic retrograde cholangiopancreatography is considered suggestive of pancreatic malignancy. Dilation of CBD and PD is frequently noted on computed tomography/magnetic resonance imaging scans, sometimes found incidentally in patients without jaundice. The prevalence of malignancy in these patients is not established.
In this retrospective analysis, consecutive patients who underwent endoscopic ultrasound (EUS) at a tertiary care hospital from 2002 to 2006 for suspected pancreatic malignancy and had double-duct sign on imaging were included. We evaluated (1) prevalence of malignancy in patients with or without obstructive jaundice and (2) performance characteristics of EUS-fine-needle aspiration (FNA) in diagnosing malignancy in this setting.
A final diagnosis of pancreatic malignancy was made in 142 (85.5%) of 166 patients with and 4 (5.9%) of 68 without obstructive jaundice (P < 0.005). The accuracy of EUS-FNA for diagnosing malignancy in patients with or without obstructive jaundice was 92.8% versus 98.5%.
Dilation of both PD and CBD on computed tomography/magnetic resonance imaging scans is suggestive of pancreatic malignancy. The prevalence of malignancy, however, is markedly lower in patients without obstructive jaundice but is clinically significant and merits further diagnostic evaluation. Endoscopic ultrasound-FNA is highly accurate for diagnosing malignancy in this setting.
内镜逆行胰胆管造影（ERCP）上的“双管征”（胆总管 [CBD] 和胰管 [PD] 均狭窄伴近端扩张）被认为提示胰腺恶性肿瘤。CBD 和 PD 的扩张在 CT/MRI 扫描上经常被发现，在没有黄疸的患者中有时也会偶然发现。这些患者的恶性肿瘤患病率尚未确定。
在这项回顾性分析中，纳入了 2002 年至 2006 年在一家三级保健医院因疑似胰腺恶性肿瘤而行内镜超声（EUS）检查且影像学上存在双管征的连续患者。我们评估了（1）有或无梗阻性黄疸患者中恶性肿瘤的患病率，以及（2）EUS 细针抽吸（FNA）在这种情况下诊断恶性肿瘤的表现特征。
在有和无梗阻性黄疸的 166 例患者中，分别有 142 例（85.5%）和 4 例（5.9%）最终被诊断为胰腺恶性肿瘤（P < 0.005）。有和无梗阻性黄疸的患者中，EUS-FNA 诊断恶性肿瘤的准确性分别为 92.8%和 98.5%。
CT/MRI 扫描上 PD 和 CBD 的扩张提示胰腺恶性肿瘤。然而，在没有梗阻性黄疸的患者中，恶性肿瘤的患病率明显较低，但具有临床意义，需要进一步的诊断评估。在这种情况下，EUS-FNA 对诊断恶性肿瘤具有高度准确性。
