Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan.
Department of Liver, Biliary Tract and Pancreas Diseases, Fujita Health University, 1-98 kutsukake-cho dengakekakubo, Toyoake, 470-1192, Japan.
BMC Gastroenterol. 2020 Mar 30;20(1):81. doi: 10.1186/s12876-020-01228-9.
Vascular invasion is an important criterion for resectability and deciding the therapeutic strategy for pancreatic ductal adenocarcinoma (PDAC), but imaging diagnosis is currently difficult. Endoscopic ultrasound (EUS) elastography (EG) images have band-like artifacts on the border between tumor and vessel due to different movement if the tumor is not connected to the vessel, i.e., no invasion. Based on this phenomenon, we assessed the usefulness of EUS-EG in the diagnosis of vascular invasion in PDAC.
The subjects were 44 out of 313 patients with PDAC who underwent EUS between January 2015 and November 2018, followed by surgery, no chemotherapy or radiotherapy, and pathological evaluation. Diagnostic accuracies of vascular invasion using dynamic computed tomography (CT), EUS B-mode and EUS-EG were compared with histopathological diagnosis.
In 44 subjects (48 sites) who underwent both dynamic CT and EUS-B mode, the sensitivity, specificity and accuracy were 0.733, 0.697 and 0.708 on dynamic CT (48 sites); 0.733, 0.606 and 0.646 in EUS B-mode (48 sites); and 0.917, 0.900 and 0.906 in EUS-EG (32 sites). In 27 subjects (29 sites) with a tumor contacting a vessel with no vascular obstruction or stenosis on dynamic CT, the sensitivity, specificity and accuracy were 0.556, 0.750 and 0.690 on dynamic CT; 0.667, 0.700 and 0.690 in EUS B-mode; and 0.889, 0.850 and 0.862 in EUS-EG.
These results suggest that EUS combined with EG improves diagnostic performance of vascular invasion in PDAC, especially in cases of which vascular invasion cannot be clearly assessed by dynamic CT.
血管侵犯是胰腺导管腺癌（PDAC）可切除性和治疗策略决策的重要标准，但目前影像学诊断较为困难。由于肿瘤与血管之间的运动不同，如果肿瘤未与血管相连，即无侵犯，则内镜超声（EUS）弹性成像（EG）图像在肿瘤与血管之间的边界处会出现带状伪影。基于这一现象，我们评估了 EUS-EG 在 PDAC 血管侵犯诊断中的应用价值。
本研究纳入了 2015 年 1 月至 2018 年 11 月期间接受 EUS 检查并随后进行手术、未接受化疗或放疗且经病理评估的 313 例 PDAC 患者中的 44 例（48 个病灶）。比较了动态 CT、EUS B 模式和 EUS-EG 对血管侵犯的诊断准确率，并与组织病理学诊断进行比较。
在同时接受动态 CT 和 EUS-B 模式检查的 44 例（48 个病灶）患者中，动态 CT 的敏感性、特异性和准确性分别为 48 个病灶的 0.733、0.697 和 0.708；EUS B 模式的敏感性、特异性和准确性分别为 48 个病灶的 0.733、0.606 和 0.646；EUS-EG 的敏感性、特异性和准确性分别为 32 个病灶的 0.917、0.900 和 0.906。在 27 例（29 个病灶）肿瘤与无血管阻塞或狭窄的血管接触的患者中，动态 CT 的敏感性、特异性和准确性分别为 29 个病灶的 0.556、0.750 和 0.690；EUS B 模式的敏感性、特异性和准确性分别为 29 个病灶的 0.667、0.700 和 0.690；EUS-EG 的敏感性、特异性和准确性分别为 29 个病灶的 0.889、0.850 和 0.862。
这些结果表明，EUS 联合 EG 可提高 PDAC 血管侵犯的诊断性能，特别是在动态 CT 无法明确评估血管侵犯的情况下。
