Cieslak Kasia P, van Santvoort Hjalmar C, Vleggaar Frank P, van Leeuwen Maarten S, ten Kate Fibo J, Besselink Marc G, Molenaar I Quintus
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
Department of Surgery, University Medical Center Utrecht, The Netherlands.
Pancreatology. 2014 Mar-Apr;14(2):125-30. doi: 10.1016/j.pan.2014.01.001. Epub 2014 Jan 10.
In patients suspected of pancreatic or periampullary cancer, abdominal contrast-enhanced computed tomography (CT) is the standard diagnostic modality. A supplementary endoscopic ultrasonography (EUS) is often performed, although there is only limited evidence of its additional diagnostic value. The aim of the study is to evaluate the additional diagnostic value of EUS over CT in deciding on exploratory laparotomy in patients suspected of pancreatic or periampullary cancer.
We retrospectively analyzed 86 consecutive patients who routinely underwent CT and EUS before exploratory laparotomy with or without pancreatoduodenectomy for suspected pancreatic or periampullary carcinoma between 2007 and 2010. Primary outcomes were visibility of a mass, resectability on CT/EUS and resection with curative intent.
A mass was visible on CT in 72/86 (84%) patients. In these 72 patients, EUS demonstrated a mass in 64/72 (89%) patients. Resectability was accurately predicted by CT in 65/72 (90%) and by EUS in 58/72 (81%) patients. In 14/86 (16%) patients no mass was seen on CT. EUS showed a mass in 12/14 (86%) of these patients. A malignant lesion was histological proven in 11/12 (92%) of these patients. Overall, resectability was accurately predicted by CT and EUS in 90% (77/86) and 84% (72/86), respectively.
In patients with a visible mass on CT, suspected for pancreatic or periampullary cancer, EUS has no additional diagnostic value, does not influence the decision to perform laparotomy and should therefore not be performed routinely. In patients without a visible mass on CT, EUS is useful to confirm the presence of a tumor.
在疑似胰腺癌或壶腹周围癌的患者中，腹部增强计算机断层扫描（CT）是标准的诊断方式。虽然内镜超声检查（EUS）的额外诊断价值证据有限，但通常也会进行该项检查。本研究的目的是评估在疑似胰腺癌或壶腹周围癌的患者中，EUS相对于CT在决定是否进行剖腹探查方面的额外诊断价值。
我们回顾性分析了2007年至2010年间86例连续患者，这些患者因疑似胰腺癌或壶腹周围癌，在进行或未进行胰十二指肠切除术的剖腹探查术前常规接受了CT和EUS检查。主要观察指标为肿块的可视性、CT/EUS上的可切除性以及根治性切除情况。
86例患者中，72例（84%）在CT上可见肿块。在这72例患者中，EUS显示64例（89%）有肿块。CT对72例患者中的65例（90%）可切除性预测准确，EUS对72例患者中的58例（81%）可切除性预测准确。86例患者中有14例（16%）在CT上未见肿块。EUS在其中12例（86%）患者中显示有肿块。这些患者中有11例（92%）经组织学证实为恶性病变。总体而言，CT和EUS对可切除性的准确预测率分别为90%（77/86）和84%（72/86）。
对于CT上可见肿块、疑似胰腺癌或壶腹周围癌的患者，EUS没有额外的诊断价值，不影响是否进行剖腹探查的决策，因此不应常规进行。对于CT上未见肿块的患者，EUS有助于确认肿瘤的存在。
