Department of Medicine and Division of Gastroenterology and Hepatology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Pancreas. 2013 May;42(4):717-21. doi: 10.1097/MPA.0b013e3182883a91.
To evaluate the performance characteristics of endoscopic ultrasonography (EUS) compared with computed tomography (CT) and magnetic resonance imaging (MRI) and determine the incremental diagnostic yield and accuracy of EUS with or without fine needle aspiration (FNA) over CT and MRI for prediction of neoplastic pancreatic cysts.
The EUS database was queried for procedures performed for pancreatic cysts between March 2006 and January 2010. Cystic pancreatic ductal adenocarcinoma, cystic pancreatic neuroendocrine tumor, mucinous cystic neoplasm, intraductal papillary neoplasm, and solid pseudopapillary neoplasm were categorized as neoplastic; pseudocysts and serous cysts were designated as nonneoplastic/low risk.
Final diagnoses were established by surgery in 154 patients (mucinous cystic neoplasm/intraductal papillary neoplasm [69.4%], pancreatic neuroendocrine tumor [10%], pancreatic ductal adenocarcinoma [6.4%], solid pseudopapillary neoplasm [0.6%], nonneoplastic/low risk [13.6%]). Endoscopic ultrasonography with or without FNA was superior to CT and MRI in accurately classifying a cyst as neoplastic (P < 0.0001). After CT and MRI, EUS increased the rate of correctly predicting neoplastic cysts in 43 (36%) and 27 (54%) additional cases, respectively.
The incremental increase in diagnostic yield of EUS and fluid analysis over CT and MRI for prediction of a neoplastic cyst is 36% and 54%, respectively. The addition of EUS-FNA to abdominal imaging significantly increases overall accuracy for diagnosis of neoplastic pancreatic cysts.
评估内镜超声检查（EUS）与计算机断层扫描（CT）和磁共振成像（MRI）的性能特征，并确定 EUS 联合或不联合细针抽吸（FNA）相对于 CT 和 MRI 预测胰腺肿瘤性囊肿的诊断效能和准确性的增量。
检索 2006 年 3 月至 2010 年 1 月间进行的胰腺囊肿 EUS 检查的数据库。胰腺导管腺癌、胰腺神经内分泌肿瘤、黏液性囊腺瘤、导管内乳头状瘤和实性假乳头状瘤被归类为肿瘤性；假性囊肿和浆液性囊肿被指定为非肿瘤性/低风险。
154 例患者最终诊断通过手术确立（黏液性囊腺瘤/导管内乳头状瘤[69.4%]、胰腺神经内分泌肿瘤[10%]、胰腺导管腺癌[6.4%]、实性假乳头状瘤[0.6%]、非肿瘤性/低风险[13.6%]）。EUS 联合或不联合 FNA 比 CT 和 MRI 更能准确地将囊肿分类为肿瘤性（P < 0.0001）。在 CT 和 MRI 之后，EUS 分别使 43（36%）和 27（54%）例额外病例正确预测肿瘤性囊肿的比率增加。
EUS 和液体分析相对于 CT 和 MRI 预测肿瘤性囊肿的诊断效能增量分别为 36%和 54%。将 EUS-FNA 与腹部成像相结合，可显著提高诊断胰腺肿瘤性囊肿的总体准确性。
