Department of Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
HPB (Oxford). 2022 Jun;24(6):809-816. doi: 10.1016/j.hpb.2021.10.005. Epub 2021 Oct 23.
The management of pancreatic body and tail lesions is underexposed. It remains unclear whether endoscopic ultrasonography (EUS) increases the accuracy of the preoperative workup. This study assessed the diagnostic value and safety of EUS in addition to cross-sectional imaging in a surgical cohort of patients with pancreatic body or tail lesions.
A multicenter retrospective cohort study was performed of patients who underwent distal pancreatectomy from 2010 to 2017. The composite primary outcome was the additional value of EUS, defined as: (a) EUS confirmed an uncertain diagnosis on cross-sectional imaging, (b) EUS was correct in case of discrepancy with cross-sectional imaging, or (c) EUS provided tissue diagnosis for neoadjuvant treatment. Furthermore, serious adverse events and needle tract seeding were assessed.
In total, 181 patients were included, of whom 123 (68%) underwent EUS besides cross-sectional imaging. Postoperative pathology was heterogeneous: 91 was malignant, 49 premalignant, 41 benign. Most lesions were solid (n = 117). EUS had additional value in 59/123 (48%) patients; 27/50 (54%) of cystic and 32/73 (44%) of solid lesions. No serious adverse event or needle tract seeding following EUS occurred.
EUS had additional value besides cross-sectional imaging in half of the patients and showed low associated risks.
胰腺体尾部病变的处理方法尚未得到充分探索。目前仍不清楚内镜超声检查（EUS）是否能提高术前检查的准确性。本研究评估了 EUS 联合影像学检查在胰腺体尾部病变手术患者中的诊断价值和安全性。
对 2010 年至 2017 年间接受胰体尾切除术的患者进行了一项多中心回顾性队列研究。复合主要结局是 EUS 的附加价值，定义为：（a）EUS 证实了影像学检查不确定的诊断；（b）EUS 与影像学检查不一致时是正确的；（c）EUS 为新辅助治疗提供了组织诊断。此外，还评估了严重不良事件和针道种植。
共纳入 181 例患者，其中 123 例（68%）除了进行影像学检查外还进行了 EUS。术后病理结果呈异质性：91 例为恶性，49 例为癌前病变，41 例为良性。大多数病变为实性（n=117）。EUS 在 59/123（48%）患者中有附加价值；50 例囊性病变中有 27 例（54%），73 例实性病变中有 32 例（44%）。EUS 后无严重不良事件或针道种植。
EUS 除了影像学检查外，在一半的患者中有附加价值，且相关风险较低。
