Trikudanathan Guru, Munigala Satish, Barlass Usman, Malli Ahmad, Han Yusheng, Sekulic Miroslav, Bellin Melena, Chinnakotla Srinath, Dunn Ty, Pruett Timothy, Beilman Gregory, Peralta Jose-Vega, Arain Mustafa, Amateau Stuart, Mallery Shawn, Freeman Martin L, Attam Rajeev
Division of Gastroenterology, University of Minnesota, Minneapolis, USA.
Division of Gastroenterology, St Louis University School of Medicine, USA.
Pancreatology. 2017 Jan-Feb;17(1):63-69. doi: 10.1016/j.pan.2016.10.010. Epub 2016 Oct 26.
Rosemont classification for chronic pancreatitis has not been evaluated specifically in non-calcific chronic pancreatitis (NCCP) patients and to this date, it has not been correlated with the gold standard namely histopathology.
To assess the correlation of EUS Rosemont criteria for NCCP with histopathology from surgical specimens and evaluate the impact of age, sex, BMI, smoking and alcohol on Rosemont classification.
Adult patients undergoing TPIAT for NCCP between July 2009 and January 2013 were identified from our institutional database. The presence or absence of standard and Rosemont (major and minor) criteria were determined by expert endosonographers using linear endosonography. Patients were categorized into normal, indeterminate and suggestive with CP based on Rosemont classification. Histology was obtained at time of TPIAT from the resected pancreas by wedge biopsy of head, body and tail. All histopathology were re-reviewed by a GI pathologist blinded to endosonographic features and clinical outcomes. Available pancreatic tissue was graded for severity of intralobular and perilobular pancreatic fibrosis by the Ammann classification system.
50 patients with NCCP (42 females, mean age± SD = 37.9 ± 10.8) underwent TPIAT with preoperative EUS during the study period. Univariate analysis of features such as age, sex, BMI, smoking and alcohol history showed no significant difference between patients identified as normal and those identified as indeterminate/suggestive (p > 0.05). Rosemont "Normal" was poor in excluding CP as 5/9 patients (55.5%) had CP on histopathology. 25/26 patients (96.2%) with features "suggestive" of CP had evidence of CP on histopathology. 12/15 patients (80.0%) with "indeterminate" features had CP on histopathology.
Rosemont classification can be used independent of patient characteristics (age, sex and BMI) and environmental factors (smoking and alcohol exposure). In our cohort, Rosemont classification was strongly predictive of CP in patients with features "suggestive" of CP. However, "normal" Rosemont classification had poor correlation in this study. This is maybe due to lack of true comparator "normal" pancreas which cannot be obtained reasonably. The strength of agreement for diagnosis of CP was substantial between the standard and Rosemont criteria.
慢性胰腺炎的罗斯蒙特分类法尚未在非钙化性慢性胰腺炎（NCCP）患者中进行专门评估，迄今为止，它尚未与金标准即组织病理学相关联。
评估NCCP的超声内镜罗斯蒙特标准与手术标本组织病理学的相关性，并评估年龄、性别、体重指数、吸烟和饮酒对罗斯蒙特分类的影响。
从我们的机构数据库中识别出2009年7月至2013年1月期间因NCCP接受胰管括约肌切开胰管引流术（TPIAT）的成年患者。由专家超声内镜医师使用线性超声内镜确定标准和罗斯蒙特（主要和次要）标准的存在与否。根据罗斯蒙特分类将患者分为正常、不确定和提示有慢性胰腺炎（CP）。在TPIAT时，通过对胰头、胰体和胰尾进行楔形活检，从切除的胰腺中获取组织学样本。所有组织病理学样本均由一位对超声内镜特征和临床结果不知情的胃肠病理学家重新审查。根据阿曼分类系统对可用的胰腺组织进行小叶内和小叶周围胰腺纤维化严重程度分级。
在研究期间，50例NCCP患者（42例女性，平均年龄±标准差 = 37.9 ± 10.8）接受了TPIAT并进行了术前超声内镜检查。对年龄、性别、体重指数、吸烟和饮酒史等特征进行单因素分析显示，被确定为正常的患者与被确定为不确定/提示有病变的患者之间无显著差异（p > 0.05）。罗斯蒙特“正常”分类在排除CP方面效果不佳，因为9例患者中有5例（55.5%）组织病理学显示有CP。26例具有CP“提示”特征的患者中有25例（96.2%）组织病理学有CP证据。15例具有“不确定”特征的患者中有12例（80.0%）组织病理学有CP。
罗斯蒙特分类可独立于患者特征（年龄、性别和体重指数）和环境因素（吸烟和饮酒暴露）使用。在我们的队列中，罗斯蒙特分类对具有CP“提示”特征的患者有很强的CP预测性。然而，在本研究中，罗斯蒙特“正常”分类的相关性较差。这可能是由于缺乏无法合理获得的真正对照“正常”胰腺。标准和罗斯蒙特标准在CP诊断方面的一致性强度很大。
