内镜超声引导下细针穿刺对胰腺转移瘤的术前预测与诊断

Pretest prediction and diagnosis of metastatic lesions to the pancreas by endoscopic ultrasound-guided fine needle aspiration.

作者信息

Krishna Somashekar G, Bhattacharya Abhik, Ross William A, Ladha Harshad, Porter Kyle, Bhutani Manoop S, Lee Jeffrey H

机构信息

Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

Department of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Medical Center, Columbus, Ohio, USA.

出版信息

J Gastroenterol Hepatol. 2015 Oct;30(10):1552-60. doi: 10.1111/jgh.12973.

DOI:10.1111/jgh.12973

PMID:25867963

Abstract

BACKGROUND AND AIM

Early diagnosis of solid pancreatic lesions (SPLs) enables prompt treatment. The study aims to identify factors differentiating metastatic lesion to the pancreas (PMET) from pancreatic ductal adenocarcinoma (PDAC) and pancreatic neuroendocrine tumors (PNETs).

METHODS

This is a retrospective study at a tertiary cancer center. Consecutive patients referred for endoscopic ultrasound (EUS) of SPLs from 2004 to 2011 were reviewed. The main outcomes were pre-EUS-FNA (endoscopic ultrasound-guided fine needle aspiration) predictors and diagnostic accuracy of EUS-FNA for PMETs.

RESULTS

Among a total of 1108 EUS-FNAs for pancreatic lesions, 672 patients had neoplastic SPLs (PMETs = 53; PDACs = 528, PNETs = 91). The sensitivity, specificity, positive predictive value, and accuracy of EUS-FNA for diagnosis of PMETs were 84.9%, 100%, 100%, and 98.8%, respectively. The mean number of EUS-FNA passes for diagnosis of PMET was 3.1 per patient. For each endosonographer, preceding 3-year EUS volume (mean/year) significantly correlated with fewer needle passes (rs [-0.30], P = 0.03). The most common PMET was renal cell carcinoma. Stratified multivariate analyses were performed. Compared with patients with PDACs, PMETs were more common in men (odds ratio [OR] = 2.0; 95% confidence interval [CI] = 1.0-4.0); located in the pancreatic tail (OR = 2.4; 95%CI = 1.1-5.2); and were less likely with increasing age (OR = 0.95; 95%CI = 0.92-0.99), presence of major symptoms (abdomen pain/diarrhea/weight loss; OR = 0.2; 95%CI = 0.1-0.4), elevated bilirubin (OR = 0.3; 95%CI = 0.13-0.69), and imaging evidence of arterial invasion (OR = 0.15; 95%CI = 0.03-0.67). Compared with PNETs, PMETs were more common with increase age (OR = 1.05; 95%CI = 1.02-1.08) and increasing lesion size (OR = 1.03; 95%CI = 1.0-1.1), and were less likely in patients with diabetes (OR = 0.34; 95%CI = 0.11-0.99).

CONCLUSION

Among the largest numbers of neoplastic SPLs evaluated at a single center, pre-test features reliably characterize, and EUS-FNA provides a highly specific diagnosis of PMETs.

摘要

背景与目的

胰腺实性病变（SPLs）的早期诊断有助于及时治疗。本研究旨在确定可区分胰腺转移瘤（PMET）与胰腺导管腺癌（PDAC）及胰腺神经内分泌肿瘤（PNETs）的因素。

方法

这是一项在三级癌症中心开展的回顾性研究。对2004年至2011年因SPLs接受内镜超声（EUS）检查的连续患者进行了回顾。主要观察指标为EUS - FNA（内镜超声引导下细针穿刺抽吸）检查前的预测指标以及EUS - FNA对PMETs的诊断准确性。

结果

在总共1108例接受EUS - FNA检查的胰腺病变患者中，672例患有肿瘤性SPLs（PMETs = 53例；PDACs = 528例，PNETs = 91例）。EUS - FNA诊断PMETs的敏感性、特异性、阳性预测值和准确性分别为84.9%、100%、100%和98.8%。诊断PMETs时每位患者EUS - FNA穿刺的平均次数为3.1次。对于每位内镜超声检查医师而言，之前3年的EUS检查量（平均每年）与较少的穿刺次数显著相关（rs[-0.30]，P = 0.03）。最常见的PMET是肾细胞癌。进行了分层多因素分析。与PDAC患者相比，PMETs在男性中更常见（比值比[OR]=2.0；95%置信区间[CI]=1.0 - 4.0）；位于胰尾（OR = 2.4；95%CI = 1.1 - 5.2）；且随着年龄增长（OR = 0.95；95%CI = 0.92 - 0.99）、出现主要症状（腹痛/腹泻/体重减轻；OR = 0.2；95%CI = 0.1 - 0.4）、胆红素升高（OR = 0.3；95%CI = 0.13 - 0.69）以及存在动脉侵犯的影像学证据（OR = 0.15；95%CI = 0.03 - 0.67）而发生的可能性较小。与PNETs相比，PMETs随着年龄增长（OR = 1.05；95%CI = 1.02 - 1.08）和病变大小增加（OR = 1.03；95%CI = 1.0 - 1.1）而更常见，而在糖尿病患者中发生的可能性较小（OR = 0.34；95%CI = 0.11 - 0.99）。