Ikemoto Juri, Serikawa Masahiro, Hanada Keiji, Eguchi Noriaki, Sasaki Tamito, Fujimoto Yoshifumi, Sugiyama Shinichiro, Yamaguchi Atsushi, Noma Bunjiro, Kamigaki Michihiro, Minami Tomoyuki, Okazaki Akihito, Yukutake Masanobu, Ishii Yasutaka, Mouri Teruo, Shimizu Akinori, Tsuboi Tomofumi, Arihiro Koji, Chayama Kazuaki
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan.
Department of Gastroenterology, Onomichi General Hospital, Onomichi 722-8508, Japan.
Diagnostics (Basel). 2021 Feb 12;11(2):287. doi: 10.3390/diagnostics11020287.
Early diagnosis of pancreatic ductal adenocarcinoma (PDAC) is challenging but essential for improving its poor prognosis. We established a multicenter study to clarify the clinicopathological features, and to propose new algorithm for early diagnosis of PDAC. Ninety-six patients with stage 0 and IA PDAC were enrolled from 13 high-volume centers. Overall, 70% of the patients were asymptomatic. The serum pancreatic enzyme levels were abnormal in half of the patients. The sensitivity of endoscopic ultrasonography (EUS) for detecting small PDAC was superior to computed tomography and magnetic resonance imaging (MRI) (82%, 58%, and 38%, respectively). Indirect imaging findings were useful to detect early-stage PDAC; especially, main pancreatic duct stenosis on MRI had the highest positive rate of 86% in stage 0 patients. For preoperative pathological diagnosis, the sensitivity of endoscopic retrograde cholangiopancreatography (ERCP)-associated pancreatic juice cytology was 84%. Among the stage IA patients, EUS-guided fine-needle aspiration revealed adenocarcinoma in 93% patients. For early diagnosis of PDAC, it is essential to identify asymptomatic patients and ensure close examinations of indirect imaging findings and standardization of preoperative pathological diagnosis. Therefore, a new diagnostic algorithm based on tumor size and imaging findings should be developed.
胰腺导管腺癌（PDAC）的早期诊断具有挑战性，但对于改善其较差的预后至关重要。我们开展了一项多中心研究，以阐明其临床病理特征，并提出PDAC早期诊断的新算法。从13个高容量中心招募了96例0期和IA期PDAC患者。总体而言，70%的患者无症状。一半患者的血清胰酶水平异常。内镜超声检查（EUS）检测小PDAC的敏感性优于计算机断层扫描和磁共振成像（MRI）（分别为82%、58%和38%）。间接影像学表现有助于检测早期PDAC；尤其是MRI上的主胰管狭窄在0期患者中的阳性率最高，为86%。对于术前病理诊断，内镜逆行胰胆管造影（ERCP）相关的胰液细胞学检查的敏感性为84%。在IA期患者中，EUS引导下细针穿刺在93%的患者中发现腺癌。对于PDAC的早期诊断，识别无症状患者并确保对间接影像学表现进行仔细检查以及术前病理诊断的标准化至关重要。因此，应基于肿瘤大小和影像学表现开发一种新的诊断算法。
