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内镜检查在胰腺导管内乳头状黏液性肿瘤管理中的当前作用。

Current roles of endoscopy in the management of intraductal papillary mucinous neoplasm of the pancreas.

作者信息

Tanaka Masao

机构信息

Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

出版信息

Dig Endosc. 2015 May;27(4):450-457. doi: 10.1111/den.12434. Epub 2015 Feb 5.

Abstract

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is characterized by intraductal papillary proliferation of mucin-producing epithelial cells that exhibit various degrees of dysplasia. IPMN is classified into four histological subtypes (gastric, intestinal, pancreatobiliary, and oncocytic) according to its histomorphological and immunohistochemical characteristics. Endoscopic retrograde cholangiopancreatography plays a crucial role in the evaluation of these features of IPMN. Endoscopic ultrasonography (EUS) has proven to be more sensitive than computed tomography or magnetic resonance imaging for early detection of malignancy. The present review addresses the current roles of endoscopy and related techniques in the management of IPMN. The particular focus is on diagnosing IPMN and malignancy within IPMN, detecting pancreatic cancer concomitant with IPMN, differentiating the epithelial subtypes of IPMN, determining the optimal strategy for the management of branch duct IPMN, and discussing innovative endoscopic technology related to IPMN. The disadvantages of endoscopic examinations of IPMN and different attitudes toward EUS-guided fine-needle aspiration for IPMN between Japan (negative) and other countries (active) are also discussed.

摘要

胰腺导管内乳头状黏液性肿瘤(IPMN)的特征是产生黏液的上皮细胞导管内乳头状增生,并表现出不同程度的发育异常。根据其组织形态学和免疫组化特征,IPMN分为四种组织学亚型(胃型、肠型、胰胆管型和嗜酸性细胞型)。内镜逆行胰胆管造影在评估IPMN的这些特征中起着关键作用。内镜超声检查(EUS)已被证明在早期检测恶性肿瘤方面比计算机断层扫描或磁共振成像更敏感。本综述阐述了内镜及相关技术在IPMN管理中的当前作用。特别关注IPMN的诊断及IPMN内的恶性肿瘤、检测与IPMN并存的胰腺癌、区分IPMN的上皮亚型、确定分支导管IPMN管理的最佳策略以及讨论与IPMN相关的创新内镜技术。还讨论了IPMN内镜检查的缺点以及日本(消极)和其他国家(积极)对EUS引导下IPMN细针穿刺的不同态度。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c04e/4964938/69c638c4c77e/DEN-27-450-g001.jpg

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