Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Pathology, Nagoya University Hospital, Nagoya, Japan.
Pancreatology. 2021 Mar;21(2):390-396. doi: 10.1016/j.pan.2020.12.022. Epub 2021 Jan 12.
Intraductal papillary mucinous neoplasm (IPMN) is reported as a high-risk factor for pancreatic cancer (PC) that includes IPMN-derived cancers (IPMC) and the development of invasive pancreatic ductal adenocarcinoma (PDAC) concomitant with IPMN. Since invasive IPMC and PDAC exhibit different oncological behaviors, their differentiation is clinically important. We aimed to investigate the use of contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) for the differential diagnosis between invasive IPMC and PDAC.
This study involved 183 consecutive patients with PC (invasive IPMC: 42, PDAC concomitant with IPMN: 9, without IPMN: 132) who underwent CEH-EUS preoperatively. While investigating the patterns, enhanced effects in the solid part of the tumor were compared with those in the surrounding pancreatic parenchyma after administration of Sonazoid® and evaluated as hyperenhanced, isoenhanced, or hypoenhanced. We retrospectively compared the enhanced pattern of CEH-EUS by using multiphasic analysis and clinicopathological factors between invasive IPMC and PDAC.
In multiphase evaluations at 20, 40 and 60 s in CEH-EUS, 75.2% (106/141) of PDACs were hypoenhanced (-) at ≥2 of the 3 time points, with significant differences from those of invasive IPMC (P < 0.001). The solid tumor diameter was significantly larger in PDAC than in invasive IPMC, and the tumor stage and preoperative serum carbohydrate antigen 19-9 level were higher. After propensity score matching of stage and solid tumor diameter, contrast enhancement patterns were significantly more persistent in invasive IPMC than in PDAC (P = 0.0013).
Multiphase evaluation using CEH-EUS is a useful method for differentiating between invasive IPMC and PDAC.
导管内乳头状黏液性肿瘤（IPMN）被报道为胰腺癌（PC）的高危因素，包括 IPMN 衍生癌（IPMC）和同时伴有 IPMN 的侵袭性胰腺导管腺癌（PDAC）的发展。由于侵袭性 IPMC 和 PDAC 表现出不同的肿瘤学行为，因此对其进行区分具有临床重要性。我们旨在研究对比增强谐波内镜超声（CEH-EUS）在侵袭性 IPMC 和 PDAC 之间的鉴别诊断中的应用。
本研究纳入了 183 例接受 CEH-EUS 术前检查的 PC 患者（侵袭性 IPMC：42 例，伴有 IPMN 的 PDAC：9 例，无 IPMN：132 例）。在研究肿瘤的强化模式时，将肿瘤实性部分的强化效果与 Sonazoid® 给药后周围胰腺实质的强化效果进行比较，并评价为高增强、等增强或低增强。我们回顾性比较了多相分析和临床病理因素在侵袭性 IPMC 和 PDAC 之间 CEH-EUS 增强模式的差异。
在 CEH-EUS 的 20、40 和 60 秒多相评估中，75.2%（106/141）的 PDAC 在≥3 个时间点中的 2 个或更多时间点呈低增强（-），与侵袭性 IPMC 相比差异有统计学意义（P<0.001）。PDAC 的实性肿瘤直径明显大于侵袭性 IPMC，肿瘤分期和术前血清碳水化合物抗原 19-9 水平更高。在对分期和实性肿瘤直径进行倾向评分匹配后，侵袭性 IPMC 的对比增强模式明显更持久（P=0.0013）。
使用 CEH-EUS 的多相评估是区分侵袭性 IPMC 和 PDAC 的有用方法。
