Li Huikai, Feng Xiuxue, Gao Fei, Chen Qianqian, Linghu Enqiang
Department of Gastroenterology and Hepatology, First Medical Center of Chinese PLA General Hospital, Beijing, China.
Endosc Ultrasound. 2023 Mar-Apr;12(2):245-250. doi: 10.4103/EUS-D-22-00064.
ERCP remains the reliable method to determine whether pancreatic cystic lesions (PCLs) and pancreatic duct communicate when other modalities (computed tomography, magnetic resonance imaging, and EUS) fail. However, complications after ERCP are still a risk that should not be ignored. In this study, we evaluated the value of EUS-guided SF6 pancreatography (ESP) for the diagnosis of PCLs focusing on pancreatic cyst communication with the pancreatic duct.
We reviewed the database of medical records to retrieve the clinicopathological data of the patients with PCLs who had undergone ESP, and analyzed the diagnostic value of ESP to determine communication between the cyst and the pancreatic duct. The inclusion criteria were as follows: (1) PCLs were pathologically diagnosed by postsurgery specimen or through-the-needle biopsy and (2) ESP was performed to determine communication between the pancreatic cyst and the pancreatic duct.
Pathological diagnosis confirmed communication with the pancreatic duct in all eight patients with positive pancreatography, among whom seven were branch-duct-intraductal papillary mucinous neoplasm (BD-IPMN) and one was the main duct-IPMN. Pathological diagnosis confirmed noncommunication with the pancreatic duct in 20 of the 21 patients with negative pancreatography, among whom 11 were mucinous cystic neoplasm, 7 were serous cystic neoplasm, 1 was solid pseudopapillary neoplasm, 1 was pancreatic pseudocyst, and 1 was BD-IPMN. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of ESP to determine communication between the pancreatic cyst and the pancreatic duct were 96.6% (28/29), 88.9% (8/9), 100% (20/20), 100% (8/8), and 95.2% (20/21), respectively.
ESP achieved high accuracy to determine communication between the pancreatic cyst and the pancreatic duct.
当其他检查方式（计算机断层扫描、磁共振成像和超声内镜）无法确定胰腺囊性病变（PCLs）与胰管是否相通时，内镜逆行胰胆管造影（ERCP）仍是可靠的诊断方法。然而，ERCP术后并发症风险仍不容小觑。本研究聚焦于PCLs与胰管相通情况，评估超声内镜引导下六氟化硫胰腺造影（ESP）对PCLs的诊断价值。
我们回顾病历数据库，检索接受ESP检查的PCLs患者的临床病理资料，并分析ESP对确定囊肿与胰管相通情况的诊断价值。纳入标准如下：（1）PCLs经手术标本病理诊断或经皮穿刺活检确诊；（2）行ESP检查以确定胰腺囊肿与胰管是否相通。
胰腺造影阳性的8例患者病理诊断均证实囊肿与胰管相通，其中7例为分支导管内乳头状黏液性肿瘤（BD-IPMN），1例为主胰管内乳头状黏液性肿瘤。胰腺造影阴性的21例患者中，20例病理诊断证实囊肿与胰管不相通，其中11例为黏液性囊性肿瘤，7例为浆液性囊性肿瘤，1例为实性假乳头状肿瘤，1例为胰腺假性囊肿，1例为BD-IPMN。ESP对确定胰腺囊肿与胰管相通情况的准确性、敏感性、特异性、阳性预测值和阴性预测值分别为96.6%（28/29）、88.9%（8/9）、100%（20/20）、100%（8/8）和95.2%（20/21）。
ESP在确定胰腺囊肿与胰管相通情况方面具有较高准确性。
