Emori Tomoya, Nuta Junya, Kawaji Yuki, Tamura Takashi, Hatamaru Keiichi, Itonaga Masahiro, Yamashita Yasunobu, Ashida Reiko, Shimokawa Toshio, Koike Masataka, Ikoma Akira, Sonomura Tetsuo, Kawai Manabu, Kitano Masayuki
Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan.
J Gastroenterol Hepatol. 2021 Dec;36(12):3402-3409. doi: 10.1111/jgh.15661. Epub 2021 Aug 31.
This study aimed to compare contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) with fundamental B-mode endoscopic ultrasonography (EUS) and contrast-enhanced computed tomography (CE-CT) for the diagnosis of left hepatic lobe metastases of pancreatic adenocarcinoma.
In this single-center prospective study, CE-CT, EUS, and CH-EUS were performed to detect left hepatic lobe metastases in patients with pancreatic adenocarcinoma, and the detection rates were compared between EUS plus CH-EUS and the other two modalities. Subgroup comparisons of between-modality detection rate were performed in patients with only metastases of <10 mm. The number of pancreatic adenocarcinoma patients whose clinical stage and treatment strategy were changed because of EUS plus CH-EUS findings was also assessed.
Thirty-one patients were diagnosed with left hepatic lobe metastases. For overall detection of left hepatic lobe metastases, EUS plus CH-EUS had significantly higher accuracy (94.3%) than CE-CT (86.7%) and EUS alone (87.6%) (P = 0.021 and P = 0.020, respectively). For detection of left hepatic lobe metastases < 10 mm, EUS plus CH-EUS (93.3%) was significantly superior to CE-CT (84.4%) and EUS alone (85.6%) (P = 0.021 and P = 0.020, respectively). In five of the 11 patients in whom only CH-EUS allowed detection of hepatic metastases, the stage and/or treatment strategy of the pancreatic adenocarcinoma was changed after CH-EUS.
This study demonstrated that EUS plus CH-EUS has advantages over CE-CT and EUS alone with regard to the accuracy of detecting left hepatic lobe metastases, particularly small hepatic metastases and accurate staging.
本研究旨在比较对比增强谐波内镜超声（CH-EUS）与基础B型内镜超声检查（EUS）及对比增强计算机断层扫描（CE-CT）在诊断胰腺腺癌左肝叶转移方面的效果。
在这项单中心前瞻性研究中，对胰腺腺癌患者进行CE-CT、EUS和CH-EUS检查以检测左肝叶转移情况，并比较EUS联合CH-EUS与其他两种检查方式的检出率。对仅存在直径<10mm转移灶的患者进行不同检查方式检出率的亚组比较。还评估了因EUS联合CH-EUS检查结果而改变临床分期和治疗策略的胰腺腺癌患者数量。
31例患者被诊断为左肝叶转移。对于左肝叶转移的总体检测，EUS联合CH-EUS的准确性（94.3%）显著高于CE-CT（86.7%）和单独的EUS（87.6%）（P分别为0.021和0.020）。对于检测直径<10mm的左肝叶转移灶，EUS联合CH-EUS（93.3%）显著优于CE-CT（84.4%）和单独的EUS（85.6%）（P分别为0.021和0.020）。在11例仅CH-EUS能检测出肝转移的患者中，有5例患者在CH-EUS检查后胰腺腺癌的分期和/或治疗策略发生了改变。
本研究表明，在检测左肝叶转移，尤其是小肝转移灶及准确分期方面，EUS联合CH-EUS比单独的CE-CT和EUS具有优势。
