Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China.
J Dig Dis. 2019 May;20(5):248-255. doi: 10.1111/1751-2980.12719. Epub 2019 Apr 16.
We aimed to evaluate the efficacy of endoscopic ultrasonography (EUS) in assessing locoregionally and determining therapeutic options for ampullary adenomas and the related factors.
Patients undergoing EUS and surgical or endoscopic resection for biopsy-proven ampullary adenomas between 2009 and 2016 were retrospectively analyzed. The depth of tumor invasion, intraductal extension, and regional lymph node staging evaluated by EUS were compared with post-treatment pathological findings.
Altogether 120 patients were enrolled in this study. The overall accuracy for EUS in T staging was 81.7%. The sensitivity and specificity of EUS for T staging were 93.9%, 45.5% for adenoma and T1, 50.0% and 96.5% for T2, 66.7% and 97.4% for T3, 50.0% and 97.5% for T4 lesions, respectively. The sensitivity, specificity, and accuracy of EUS for the diagnosis of any intraductal extension were 89.5%, 86.1%, and 86.7%, respectively. The overall accuracy of EUS for regional lymph node staging was 75.0%. The sensitivity and specificity of EUS for diagnosing N1 were 62.5% and 87.5%. By multivariate analysis no factors were found to be independently associated with EUS accuracy for tumor invasive depth. However, small lesion size (≤15 mm) and dilated duct were associated with an overestimation in intraductal extension.
EUS may be a useful diagnostic tool for selecting endoscopic or surgical treatment for ampullary adenomas.
评估内镜超声（EUS）在评估局部区域和确定壶腹腺瘤的治疗选择方面的疗效及其相关因素。
回顾性分析了 2009 年至 2016 年间经 EUS 检查并经手术或内镜切除活检证实为壶腹腺瘤的患者。将 EUS 评估的肿瘤浸润深度、管内延伸和区域淋巴结分期与治疗后病理结果进行比较。
本研究共纳入 120 例患者。EUS 对 T 分期的总体准确性为 81.7%。EUS 对 T 分期的灵敏度和特异性分别为 93.9%、45.5%用于腺瘤和 T1 期，50.0%和 96.5%用于 T2 期，66.7%和 97.4%用于 T3 期，50.0%和 97.5%用于 T4 期病变。EUS 对任何管内延伸的诊断灵敏度、特异性和准确性分别为 89.5%、86.1%和 86.7%。EUS 对区域淋巴结分期的总体准确性为 75.0%。EUS 对 N1 诊断的灵敏度和特异性分别为 62.5%和 87.5%。多因素分析发现，没有因素与肿瘤浸润深度的 EUS 准确性独立相关。然而，小病变大小（≤15mm）和扩张的胆管与管内延伸的高估有关。
EUS 可能是选择内镜或手术治疗壶腹腺瘤的有用诊断工具。
