Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Department of Pathology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Dig Endosc. 2018 Jan;30(1):98-106. doi: 10.1111/den.12900. Epub 2017 Jul 16.
Differential diagnosis of localized gallbladder lesions is challenging. The aim of the present study was to evaluate the utility of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for diagnosis of localized gallbladder lesions.
One hundred and twenty-five patients with localized gallbladder lesions were evaluated by CH-EUS between March 2007 and February 2014. This was a single-center retrospective study. Utilities of fundamental B-mode EUS (FB-EUS) and CH-EUS in the differentiation of gallbladder lesions and sludge plug were initially compared. Thereafter, these two examinations were compared with respect to their accuracy in the diagnosis of malignant lesions. Five reviewers blinded to the clinicopathological results evaluated microcirculation patterns in the vascular and perfusion images.
In the differentiation between gallbladder lesions and sludge plug, FB-EUS had a sensitivity, specificity, and accuracy of 82%, 100%, and 95%, respectively, whereas CH-EUS had a sensitivity, specificity, and accuracy of 100%, 99%, and 99%, respectively. FB-EUS-based diagnosis of carcinomas based on tumor size and/or shape had a sensitivity, specificity, and accuracy of 61-87%, 71-88%, and 74-86%, respectively. Additional information regarding irregular vessel patterns in the vascular image and/or heterogeneous enhancement in the perfusion image on CH-EUS increased the sensitivity, specificity, and accuracy for the diagnosis of carcinomas to 90%, 98%, and 96%, respectively. There was a significant difference between FB-EUS and CH-EUS in terms of carcinoma diagnosis.
CH-EUS was useful for the evaluation of localized gallbladder lesions.
局限性胆囊病变的鉴别诊断具有挑战性。本研究旨在评估对比增强谐波内镜超声（CH-EUS）在诊断局限性胆囊病变中的应用价值。
2007 年 3 月至 2014 年 2 月，我们对 125 例局限性胆囊病变患者进行了 CH-EUS 检查。这是一项单中心回顾性研究。我们最初比较了基本型灰阶超声（FB-EUS）和 CH-EUS 在鉴别胆囊病变和胆泥栓方面的应用价值。然后，我们比较了这两种检查方法在诊断恶性病变方面的准确性。5 位对临床病理结果不知情的评估者评估了血管和灌注图像中的微循环模式。
在鉴别胆囊病变和胆泥栓方面，FB-EUS 的灵敏度、特异度和准确度分别为 82%、100%和 95%，而 CH-EUS 的灵敏度、特异度和准确度分别为 100%、99%和 99%。基于肿瘤大小和/或形状，FB-EUS 诊断癌的灵敏度、特异度和准确度分别为 61%-87%、71%-88%和 74%-86%。CH-EUS 血管图像中不规则血管模式和/或灌注图像中不均匀增强的附加信息将癌的诊断灵敏度、特异度和准确度分别提高到 90%、98%和 96%。FB-EUS 和 CH-EUS 在诊断癌方面有显著差异。
CH-EUS 有助于评估局限性胆囊病变。
