Kawaguchi Yoshiaki, Mine Tetsuya
Yoshiaki Kawaguchi, Tetsuya Mine, Department of Gastroenterology, Tokai University School of Medicine, Isehara 259-1193, Japan.
World J Gastrointest Oncol. 2016 Feb 15;8(2):159-64. doi: 10.4251/wjgo.v8.i2.159.
Because of the aging of the population, prevalence of medical checkups, and advances in imaging studies, the number of pancreatic cystic lesions detected has increased. Once these lesions are detected, neoplastic cysts should be differentiated from non-neoplastic cysts. Furthermore, because of the malignant potential of some neoplastic pancreatic cysts, further differentiation between benign and malignant cysts should be made regardless of their size. Although endoscopic ultrasound (EUS) has a very high diagnostic performance for pancreatic cystic lesions among the various imaging modalities, EUS findings alone are insufficient for the differentiation of pancreatic cysts and diagnosis of malignancy. In addition, cytology by EUS-guided fine-needle aspiration (FNA) has a high specificity but a low sensitivity for diagnosing malignancy in pancreatic cystic tumors. The levels of amylase, lipase, and tumor markers in pancreatic cystic fluid are considered auxiliary parameters for diagnosis of benign and malignant cysts, and a definitive diagnosis of malignancy using these parameters is difficult. Thus, in addition to EUS, cytology by EUS-FNA, and cystic fluid analysis, new techniques based on EUS-guided through-the-needle imaging, such as confocal laser endomicroscopy and cystoscopy, have been explored in recent years.
由于人口老龄化、体检普及以及影像学研究的进展，检测到的胰腺囊性病变数量有所增加。一旦发现这些病变，就应将肿瘤性囊肿与非肿瘤性囊肿区分开来。此外，由于一些胰腺肿瘤性囊肿具有恶性潜能，无论囊肿大小，都应进一步区分良性和恶性囊肿。尽管在各种成像方式中，内镜超声（EUS）对胰腺囊性病变具有很高的诊断性能，但仅凭EUS检查结果不足以区分胰腺囊肿和诊断恶性肿瘤。此外，EUS引导下细针穿刺抽吸（FNA）进行的细胞学检查对胰腺囊性肿瘤诊断恶性肿瘤具有高特异性但低敏感性。胰腺囊液中的淀粉酶、脂肪酶和肿瘤标志物水平被视为诊断良性和恶性囊肿的辅助参数，使用这些参数明确诊断恶性肿瘤很困难。因此，近年来除了EUS、EUS-FNA细胞学检查和囊液分析外，还探索了基于EUS引导的针内成像的新技术，如共聚焦激光内镜显微镜检查和囊肿镜检查。
