Li Angela E, Li Bob T, Ng Bernard H K, McCormack Sam, Vedelago John, Clarke Stephen, Pavlakis Nick, Samra Jaswinder
Department of Radiology, Royal Prince Alfred Hospital, Camperdown NSW 2050, Australia.
Department of Medical Oncology, Royal North Shore Hospital, St Leonards NSW 2065, Australia.
World J Oncol. 2013 Apr;4(2):74-82. doi: 10.4021/wjon657w. Epub 2013 May 6.
The extent of vascular invasion is a key factor determining the resectability of non-metastatic pancreatic adenocarcinoma. The purpose of this study is to determine the diagnostic accuracy of computed tomography (CT), endoscopic ultrasound (EUS), and magnetic resonance imaging (MRI) in the pre-operative evaluation of vascular invasion in pancreatic adenocarcinoma, with surgery as the reference standard.
A search of the MEDLINE database for relevant articles in the English language published between January 2000 and February 2009 was performed. From each study, 2 × 2 tables were obtained, and pooled sensitivity, specificity, positive likelihood ratios, negative likelihood ratios and diagnostic odds ratios were calculated for each modality, along with a summary receiver operating characteristics (SROC) curve.
16 studies with a total of 797 patients who had surgical assessment of vascular invasion were included in the analysis. Several studies evaluated more than one imaging modality, allowing 24 datasets to be obtained in total. Sensitivity was highest for CT (0.73, 95% CI 0.67 - 0.79), followed by EUS (0.66, 95% CI 0.56 - 0.75) and MRI (0.63, 95% CI 0.48 - 0.77). The specificity for all three imaging modalities was comparable. The diagnostic odds ratios for CT, EUS and MRI were 45.9 (95% CI 18.0 - 117.4), 23.0 (95%CI 9.4 - 56.6), 23.9 (95% CI 5.4 - 105.1) respectively.
CT was more accurate than EUS and MRI in the evaluation of vascular invasion in pancreatic adenocarcinoma and should be the first line investigation in pre-operative staging.
血管侵犯程度是决定非转移性胰腺腺癌可切除性的关键因素。本研究旨在以手术为参考标准，确定计算机断层扫描（CT）、内镜超声（EUS）和磁共振成像（MRI）在术前评估胰腺腺癌血管侵犯方面的诊断准确性。
检索MEDLINE数据库中2000年1月至2009年2月发表的英文相关文章。从每项研究中获取2×2列联表，并计算每种检查方法的合并敏感度、特异度、阳性似然比、阴性似然比和诊断比值比，同时绘制汇总受试者工作特征（SROC）曲线。
分析纳入了16项研究，共797例接受血管侵犯手术评估的患者。多项研究评估了不止一种成像检查方法，共获得24个数据集。CT的敏感度最高（0.73，95%可信区间0.67 - 0.79），其次是EUS（0.66，95%可信区间0.56 - 0.75）和MRI（0.63，95%可信区间0.48 - 0.77）。三种成像检查方法的特异度相当。CT、EUS和MRI的诊断比值比分别为45.9（95%可信区间18.0 - 117.4）、23.0（95%可信区间9.4 - 56.6）、23.9（95%可信区间5.4 - 105.1）。
在评估胰腺腺癌血管侵犯方面，CT比EUS和MRI更准确，应作为术前分期的一线检查方法。
