在慢性胰腺炎中，小叶状而非内镜超声检查中的高回声灶/条索状与更严重的组织学特征相关。

Lobularity rather than hyperechoic foci/stranding on endoscopic ultrasonography is associated with more severe histological features in chronic pancreatitis.

作者信息

Inomata Noriko, Masuda Atsuhiro, Yamakawa Kohei, Takenaka Mamoru, Tsujimae Masahiro, Toyama Hirochika, Sofue Keitaro, Sakai Arata, Kobayashi Takashi, Tanaka Takeshi, Yamada Yasutaka, Ashina Shigeto, Gonda Masanori, Abe Shohei, Masuda Shigeto, Uemura Hisahiro, Kohashi Shinya, Nagao Kae, Harada Yoshiyuki, Miki Mika, Nakano Ryota, Shiomi Hideyuki, Kanzawa Maki, Itoh Tomoo, Fukumoto Takumi, Kodama Yuzo

机构信息

Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.

Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.

出版信息

J Gastroenterol Hepatol. 2023 Jan;38(1):103-111. doi: 10.1111/jgh.16047. Epub 2022 Nov 9.

DOI:10.1111/jgh.16047

PMID:36308059

Abstract

BACKGROUND AND AIM

Endoscopic ultrasonography (EUS) findings of the pancreatic parenchyma, such as hyperechoic foci/stranding and lobularity, may be associated with the severity of chronic pancreatitis (CP). However, the correlation between parenchymal EUS findings and histology remains unclear. We designed a large-scale retrospective study analyzing over 200 surgical specimens to elucidate the association between parenchymal EUS findings and histological features.

METHODS

Clinical data of 221 patients with pancreatobiliary tumors who underwent preoperative EUS and pancreatic surgery between January 2010 and November 2020 were reviewed to investigate the association between parenchymal EUS findings and histological features at the pancreatic body. None of these patients met the definition of CP.

RESULTS

Of the 221 patients, 87 (39.4%), 89 (40.2%), and 45 (20.4%) had normal EUS findings, hyperechoic foci/stranding without lobularity, and hyperechoic foci/stranding with lobularity, respectively. In the multivariate analyses, parenchymal EUS findings significantly correlated with histological CP findings of fibrosis, inflammation, and atrophy (hyperechoic foci/stranding without lobularity vs hyperechoic foci/stranding with lobularity, odds ratio [95% confidence interval]: 4.1 [2.2-7.9] vs 31.3 [9.3-105.6], P < 0.001; 3.9 [1.9-8.2] vs 21.8 [8.0-59.4], P < 0.001; and 4.0 [2.0-7.8] vs 22.9 [7.0-74.5], P < 0.001, respectively). Further, a trend toward higher histological grade was observed in the following order: normal findings, hyperechoic foci/stranding without lobularity, and hyperechoic foci/stranding with lobularity.

CONCLUSIONS

Endoscopic ultrasonography findings of the pancreatic parenchyma may be associated with the histological conditions in CP, such as pancreatic fibrosis, inflammation, and atrophy. Lobularity reflects more severe histological conditions than does hyperechoic foci/stranding.

摘要

背景与目的

胰腺实质的内镜超声（EUS）表现，如高回声灶/条索状影和小叶状改变，可能与慢性胰腺炎（CP）的严重程度相关。然而，实质EUS表现与组织学之间的相关性仍不明确。我们设计了一项大规模回顾性研究，分析200多份手术标本，以阐明实质EUS表现与组织学特征之间的关联。

方法

回顾2010年1月至2020年11月期间221例接受术前EUS和胰腺手术的胰胆肿瘤患者的临床资料，以研究胰腺体部实质EUS表现与组织学特征之间的关联。这些患者均不符合CP的定义。

结果

221例患者中，EUS表现正常、有高回声灶/条索状影但无小叶状改变、有高回声灶/条索状影且有小叶状改变的分别有87例（39.4%）、89例（40.2%）和45例（20.4%）。在多因素分析中，实质EUS表现与组织学CP表现中的纤维化、炎症和萎缩显著相关（有高回声灶/条索状影但无小叶状改变与有高回声灶/条索状影且有小叶状改变相比，比值比[95%置信区间]：4.1[2.2 - 7.9]对31.3[9.3 - 105.6]，P < 0.001；3.9[1.9 - 8.2]对21.8[8.0 - 59.4]，P < 0.001；4.0[2.0 - 7.8]对22.9[7.0 - 74.5]，P < 0.001）。此外，观察到组织学分级呈以下趋势升高：正常表现、有高回声灶/条索状影但无小叶状改变、有高回声灶/条索状影且有小叶状改变。