Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan.
Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Am Surg. 2021 Apr;87(4):664-669. doi: 10.1177/0003134820954851. Epub 2020 Nov 6.
Differential diagnosis between pancreatic head cancer (PHC) and intrapancreatic bile duct cancer (BDC) is important, but no clinical standard has been established. Here we examine the diagnostic utility of bile duct axis deviation and other clinical factors for this differential diagnosis.
This study enrolled patients who underwent pancreaticoduodenectomy for PHC or BDC at our center between 2009 and 2016. PHCs in groove or uncinate portions were excluded from analysis. From contrast-enhanced computed tomography images, the bile duct angle (BDA) was measured using three points: the junction of intrahepatic bile ducts, upper pancreatic edge, and Vater papilla. Logistic regression was performed to evaluate the diagnostic performance of BDA and other clinical factors for differential diagnosis.
During the study period, 22 PHCs and 31 BDCs were resected. The combination of BDA ≤ 130°, main pancreatic duct diameter ≥ 4.3 mm, and absence of jaundice predicted PHC rather than BDC with an area under the curve of the receiver-operator characteristics curve of .856 (95% confidence interval, .766-.947).
Clinical findings of larger bile duct axis deviation, main pancreatic duct dilation, and the absence of jaundice may be useful for distinguishing PHC from BDC.
胰头癌（PHC）和胰内胆管癌（BDC）的鉴别诊断很重要，但尚未建立临床标准。在此，我们研究了胆管轴偏斜和其他临床因素在这种鉴别诊断中的诊断效用。
本研究纳入了 2009 年至 2016 年在我院接受胰十二指肠切除术治疗的 PHC 或 BDC 患者。从增强 CT 图像上测量胆管角（BDA），使用三个点：肝内胆管交界处、胰上缘和 Vater 乳头。采用 logistic 回归分析 BDA 及其他临床因素对鉴别诊断的诊断性能。
研究期间，共切除 22 例 PHC 和 31 例 BDC。BDA≤130°、主胰管直径≥4.3mm 且无黄疸的组合可预测 PHC 而非 BDC，受试者工作特征曲线下面积为 0.856（95%置信区间，0.766-0.947）。
较大的胆管轴偏斜、主胰管扩张和无黄疸的临床发现可能有助于鉴别 PHC 和 BDC。
