组织谐波与对比增强谐波内镜超声检查在胰腺肿瘤诊断中的应用：前瞻性多中心研究

Tissue harmonic versus contrast-enhanced harmonic endoscopic ultrasonography for the diagnosis of pancreatic tumors: Prospective multicenter study.

作者信息

Omoto Shunsuke, Kitano Masayuki, Fukasawa Mitsuharu, Ashida Reiko, Kato Hironari, Shiomi Hideyuki, Sugimori Kazuya, Kanno Atsushi, Chiba Yasutaka, Takano Shinichi, Yamamoto Naoki, Ezaki Takeshi, Miwa Haruo, Yokomura Akitaka, Hoshikawa Masato, Tanaka Takamitsu, Kudo Masatoshi

机构信息

Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan.

Second Department of Internal Medicine, Wakayama Medical University School of Medicine, Wakayama, Japan.

出版信息

Dig Endosc. 2022 Jan;34(1):198-206. doi: 10.1111/den.13944. Epub 2021 Apr 10.

DOI:10.1111/den.13944

PMID:33547825

Abstract

OBJECTIVES

This prospective multicenter study aimed to assess and compare the accuracy of tissue harmonic endoscopic ultrasonography (TH-EUS) and contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for differentiating pancreatic carcinoma from other pancreatic tumors.

METHODS

Consecutive patients with solid pancreatic tumors were prospectively enrolled between August 2013 and December 2014. To assess the accuracy of TH-EUS and CH-EUS, we compared four parameters of TH-EUS (fuzzy edge, irregular periphery, hypoechogenicity, and heterogeneous internal echogenicity) and four parameters of CH-EUS (hypoenhancement and heterogeneous enhancement in the early and late phases, respectively) to investigate which parameter of each method was most suitable to diagnose pancreatic carcinomas. Interobserver agreement and the diagnostic ability of pancreatic carcinoma using TH-EUS and CH-EUS were assessed and compared.

RESULTS

A total of 204 patients were enrolled. For the diagnosis of pancreatic carcinoma, interobserver agreement by experts and nonexperts was 0.33-0.50 and 0.35-0.50 for TH-EUS, respectively, and 0.72-0.74 and 0.20-0.54 for CH-EUS, respectively. Irregular periphery was the most accurate diagnostic parameter among TH-EUS findings for differentiating pancreatic carcinomas, with sensitivity, specificity, and accuracy of 95.0%, 42.9%, and 78.9%, respectively. Late phase hypoenhancement was the most accurate diagnostic parameter among CH-EUS findings for differentiating pancreatic carcinomas, with sensitivity, specificity, and accuracy of 90.8%, 74.6%, and 85.8%, respectively. The accuracy of CH-EUS (late phase hypoenhancement) for diagnosis of pancreatic carcinoma was significantly higher than that of TH-EUS (irregular periphery) (p < 0.001).

CONCLUSION

In comparison with TH-EUS, CH-EUS increased the diagnostic ability and reproducibility for the diagnosis of pancreatic carcinoma. UMIN (000011124).

摘要

目的

本前瞻性多中心研究旨在评估和比较组织谐波内镜超声检查（TH-EUS）和对比增强谐波内镜超声检查（CH-EUS）鉴别胰腺癌与其他胰腺肿瘤的准确性。

方法

2013年8月至2014年12月前瞻性纳入连续的实性胰腺肿瘤患者。为评估TH-EUS和CH-EUS的准确性，我们比较了TH-EUS的四个参数（模糊边缘、不规则边界、低回声性和内部回声不均匀性）和CH-EUS的四个参数（分别为早期和晚期低增强及增强不均匀），以研究每种方法的哪个参数最适合诊断胰腺癌。评估并比较了观察者间的一致性以及使用TH-EUS和CH-EUS诊断胰腺癌的能力。

结果

共纳入204例患者。对于胰腺癌的诊断，专家和非专家使用TH-EUS时观察者间一致性分别为0.33 - 0.50和0.35 - 0.50，使用CH-EUS时分别为0.72 - 0.74和0.20 - 0.54。在TH-EUS鉴别胰腺癌的表现中，不规则边界是最准确的诊断参数，敏感性、特异性和准确性分别为95.0%、42.9%和78.9%。在CH-EUS鉴别胰腺癌的表现中，晚期低增强是最准确的诊断参数，敏感性、特异性和准确性分别为90.8%、74.6%和85.8%。CH-EUS（晚期低增强）诊断胰腺癌的准确性显著高于TH-EUS（不规则边界）（p < 0.001）。