Zhang Chen, Wang Lixue, Zheng Zhuozhao, Yao Jingjing, He Li, Li Jie
Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, 168 Litang Road, Changping District, Beijing, 102218, China.
Department of Pathology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Abdom Radiol (NY). 2023 Feb;48(2):601-607. doi: 10.1007/s00261-022-03752-6. Epub 2022 Nov 27.
The aim of this study was to investigate the value of multi-slice computed tomography (MSCT) in preoperatively diagnosing perineural invasion (PNI) of periampullary carcinoma (PAC).
Of 81 patients pathologically diagnosed as PAC, 73 patients were included. Their clinical documents and preoperative upper abdominal enhanced MSCT images were retrospectively reviewed to analyse clinical characteristics and MSCT features. MSCT features included tumor size, classification of fat tissue around celiac trunk and superior mesenteric artery. Chi-square test, Mann-Whitney U test or Fisher's exact test were used to compare the differences between PNI group and Non-PNI group. ROC analysis was performed to evaluate diagnostic efficiency for PAC PNI.
There were significant differences in some clinical characteristics and MSCT features. PAC PNI patients had significantly higher CA19-9 levels, higher CEA levels, larger tumor size and higher classification of fat tissue around celiac trunk than Non-PNI patients (All P values < 0.05). In univariate analysis, tumor size had the highest AUC as 0.806, fat tissue around celiac trunk and CEA had the highest specificity as 100% (P < 0.001). In multivariate analysis, classification of fat tissue around celiac trunk incorporated with tumor size, CA19-9, CEA, age and sex, showed the highest AUC as 0.939, with specificity of 95.0% and sensitivity of 90.4% (P < 0.001).
PAC PNI could be diagnosed preoperatively by evaluating abdominal enhanced MSCT images with high accuracy, combined with serum tumor marker could be more helpful.
本研究旨在探讨多层螺旋计算机断层扫描（MSCT）在术前诊断壶腹周围癌（PAC）神经周围侵犯（PNI）中的价值。
纳入81例经病理诊断为PAC的患者中的73例。回顾性分析其临床资料及术前上腹部增强MSCT图像，以分析临床特征和MSCT特征。MSCT特征包括肿瘤大小、腹腔干和肠系膜上动脉周围脂肪组织分类。采用卡方检验、曼-惠特尼U检验或费舍尔精确检验比较PNI组和非PNI组之间的差异。进行ROC分析以评估PAC PNI的诊断效率。
一些临床特征和MSCT特征存在显著差异。与非PNI患者相比，PAC PNI患者的CA19-9水平显著更高、CEA水平更高、肿瘤更大且腹腔干周围脂肪组织分类更高（所有P值<0.05）。单因素分析中，肿瘤大小的AUC最高为0.806，腹腔干周围脂肪组织和CEA的特异性最高为100%（P<0.001）。多因素分析中，腹腔干周围脂肪组织分类结合肿瘤大小、CA19-9、CEA、年龄和性别，AUC最高为0.939，特异性为95.0%，敏感性为90.4%（P<0.001）。
通过评估腹部增强MSCT图像可高精度地术前诊断PAC PNI，结合血清肿瘤标志物可能更有帮助。
