Sato Ai, Irisawa Atsushi, Bhutani Manoop S, Shibukawa Goro, Yamabe Akane, Fujisawa Mariko, Igarashi Ryo, Arakawa Noriyuki, Yoshida Yoshitsugu, Abe Yoko, Maki Takumi, Hoshi Koki, Ohira Hiromasa
Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Tanisawa, Kawahigashi, Aizuwakamatsu, Japan.
Department of Gastroenterology Hepatology and Nutrition, Unit 1466, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA.
Endosc Ultrasound. 2018 Mar-Apr;7(2):110-118. doi: 10.4103/2303-9027.209870.
The Rosemont classification (RC) was developed as a consensus-based standard for the diagnosis of chronic pancreatitis (CP) by endoscopic ultrasonography (EUS), however, it is more complicated than the conventional scoring system. We have noticed that in the early stages of CP, it is not unusual to observe pancreas with abnormal appearance coexisting with the areas of normal parenchyma. The aim of this study was to investigate the validity of a "normal" pancreas appearance and to evaluate the usefulness of modified diagnostic criteria in comparison to the traditional EUS criteria and the RC.
One hundred and seventy-seven patients who had undergone both EUS and endoscopic retrograde pancreatography (ERP) within 2 months were enrolled in the study, and patients with pancreatic cancer were excluded from the study. ERP findings were used as the gold standard for the diagnosis of CP. The EUS images obtained were classified according to both the RC and our new modified criteria. The latter includes an additional criterion to the modified traditional criteria: fine-reticular pattern (F-RP) was defined as a normal pancreatic parenchyma. We compared the accuracy between the new modified EUS criteria and the RC.
(1) Normal or equivocal findings on ERP were obtained for 132 patients; 113 patients had F-RP on EUS. In contrast, F-RP was found in only 6 out of 45 CP cases on ERP (P < 0.0001). (2) We investigated the diagnostic capability of our new criteria for endoscopic retrograde cholangiopancreatography normal/equivocal pancreas compared to the traditional criteria. In cases where fewer than two points were defined as normal, the incidence of normal pancreas was significantly higher based on the new criteria than on the traditional criteria (P = 0.002). (3) No significant differences were found between the new criteria and the RC across all ERP grades.
Our new proposed "normal-added EUS criteria" for diagnosing CP was equivalent to the RC.
罗斯蒙特分类法（RC）是一种基于共识制定的标准，用于通过内镜超声（EUS）诊断慢性胰腺炎（CP），然而，它比传统评分系统更为复杂。我们注意到，在CP的早期阶段，常可见外观异常的胰腺与正常实质区域并存。本研究的目的是探讨“正常”胰腺外观的有效性，并与传统EUS标准和RC相比，评估改良诊断标准的实用性。
本研究纳入了177例在2个月内接受了EUS和内镜逆行胰胆管造影（ERP）的患者，胰腺癌患者被排除在研究之外。ERP检查结果被用作CP诊断的金标准。所获得的EUS图像根据RC和我们新的改良标准进行分类。后者在改良的传统标准基础上增加了一项标准：细网状模式（F-RP）被定义为正常胰腺实质。我们比较了新的改良EUS标准与RC之间的准确性。
（1）132例患者ERP检查结果正常或不明确；113例患者EUS检查显示有F-RP。相比之下，45例CP患者中只有6例在ERP检查时有F-RP（P<0.0001）。（2）我们研究了新标准相对于传统标准对内镜逆行胰胆管造影正常/不明确胰腺的诊断能力。在定义为正常的点数少于2个的病例中，基于新标准的正常胰腺发生率显著高于传统标准（P=0.002）。（3）在所有ERP分级中，新标准与RC之间未发现显著差异。
我们新提出的用于诊断CP的“增加正常标准的EUS标准”与RC相当。
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