Guo Tao, Xu Tao, Zhang Shengyu, Lai Yamin, Wu Xi, Wu Dongsheng, Feng Yunlu, Jiang Qingwei, Wang Qiang, Qian Jiaming, Yang Aiming
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Depatment of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China.
Endosc Ultrasound. 2021 Jul-Aug;10(4):280-287. doi: 10.4103/EUS-D-20-00212.
The clinical presentation of focal autoimmune pancreatitis (FAIP) and together with radiological overlap can mimic pancreatic cancer (PC). The aim of this study is to construct and validate a prediction model for differentiating FAIP from PC according to EUS characteristics.
Ninety patients with FAIP and 196 patients with PC, who consecutively underwent EUS at our center from January 2013 to December 2018, were retrospectively included in the study. The enrolled patients were randomly divided into either a derivation sample or a validation sample. According to EUS characteristics, multivariate stepwise logistic regression and receiver operating characteristics (ROC) analyses were used to construct a prediction model in derivation sample, and then, the efficacy was assessed in validation sample.
EUS characteristics that were suggestive of FAIP included diffuse hypoechogenicity, hyperechoic foci/stands or lobularity (parenchymal heterogeneity), bile duct wall thickening and peripancreatic hypoechoic margin; and EUS features favoring PC included focal hypoechogenicity, absence of parenchymal heterogeneity, pancreatic duct dilation, and vessel involvement. The prediction model, with an area under the ROC curve of more than 0.95, had a good capability to distinguish FAIP from PC. By using the optimal cutoff value, the efficacy of model for diagnosing PC showed 83.7%-91.8% sensitivity and 93.3%-95.6% specificity.
It is feasible to differentiate FAIP from PC based on EUS characteristics. The prediction model built in this study needs to be further confirmed by multicenter prospective researches.
局灶性自身免疫性胰腺炎（FAIP）的临床表现以及影像学表现可能与胰腺癌（PC）相似。本研究旨在构建并验证一种基于超声内镜（EUS）特征鉴别FAIP与PC的预测模型。
回顾性纳入2013年1月至2018年12月在本中心连续接受EUS检查的90例FAIP患者和196例PC患者。将纳入的患者随机分为推导样本或验证样本。根据EUS特征，在推导样本中采用多因素逐步逻辑回归和受试者操作特征（ROC）分析构建预测模型，然后在验证样本中评估其效能。
提示FAIP的EUS特征包括弥漫性低回声、高回声灶/条索或小叶状（实质异质性）、胆管壁增厚和胰腺周围低回声边缘；支持PC的EUS特征包括局灶性低回声、无实质异质性、胰管扩张和血管受累。该预测模型的ROC曲线下面积大于0.95，具有良好的区分FAIP与PC的能力。采用最佳截断值时，该模型诊断PC的效能显示敏感性为83.7%-91.8%，特异性为93.3%-95.6%。
基于EUS特征鉴别FAIP与PC是可行的。本研究构建的预测模型需要多中心前瞻性研究进一步验证。
