Kanazawa Keisuke, Chiba Masafumi, Kato Masayuki, Kinoshita Yuji, Akasu Takafumi, Matsui Hiroaki, Shimamoto Nana, Tomita Youichi, Abe Takahiro, Tsukinaga Shintaro, Nakano Masanori, Torisu Yuichi, Toyoizumi Hirobumi, Sumiyama Kazuki
Department of Endoscopy, The Jikei University School of Medicine, Tokyo 105-8461, Japan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan.
Diagnostics (Basel). 2022 Aug 16;12(8):1983. doi: 10.3390/diagnostics12081983.
Background: The utility of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) alone in the biliopancreatic region appears to be limited because it is highly dependent on the experience and skill of the endoscopist. Therefore, the present study aimed to validate the efficacy of CH-EUS in clinical practice. Methods: Between January 2018 and March 2019, 301 consecutive patients who underwent CH-EUS were prospectively enrolled in this study. The diagnostic performance of CH-EUS was compared with that of dynamic computed tomography (CT), magnetic resonance imaging (MRI), and all combinations (i.e., CH-EUS, dynamic CT, and MRI) using a Bonferroni correction. A multiple logistic regression analysis was performed to extract each disease that allowed the CH-EUS diagnosis to be consistent with the final diagnosis. Results: In multiple comparisons of diagnostic performance, no significant differences were observed among dynamic CT, MRI, and CH-EUS (p = 1.00), but the diagnostic performance was significantly higher when all modalities were combined (p < 0.001). Moreover, only intraductal papillary mucinous neoplasm comprising adenoma or carcinoma (IPMN, n = 161) showed significance with respect to the agreement with the final diagnosis (p = 0.006). Conclusions: Our results showed that CH-EUS-based diagnosis of IPMN may be possible in clinical practice. On the contrary, to accurately diagnose biliopancreatic diseases other than IPMN, comprehensive diagnosis using multiple modalities may be necessary, rather than relying on CH-EUS alone.
单纯的对比增强谐波内镜超声检查（CH-EUS）在胆胰区域的应用似乎有限，因为它高度依赖内镜医师的经验和技能。因此，本研究旨在验证CH-EUS在临床实践中的有效性。方法：在2018年1月至2019年3月期间，连续301例接受CH-EUS检查的患者被前瞻性纳入本研究。使用Bonferroni校正比较CH-EUS与动态计算机断层扫描（CT）、磁共振成像（MRI）以及所有组合（即CH-EUS、动态CT和MRI）的诊断性能。进行多因素逻辑回归分析以提取每种能使CH-EUS诊断与最终诊断一致的疾病。结果：在诊断性能的多重比较中，动态CT、MRI和CH-EUS之间未观察到显著差异（p = 1.00），但当所有检查方式联合使用时诊断性能显著更高（p < 0.001）。此外，仅导管内乳头状黏液性肿瘤（包括腺瘤或癌，IPMN，n = 161）在与最终诊断的一致性方面具有显著性（p = 0.006）。结论：我们的结果表明，在临床实践中基于CH-EUS诊断IPMN是可能的。相反，要准确诊断IPMN以外的胆胰疾病，可能需要使用多种检查方式进行综合诊断，而不是仅依赖CH-EUS。
