Department of Gastroenterology, Oita San-ai Medical Center, Oita, Japan.
Pancreatic Cancer Research for Secure Salvage Young Investigators (PASSYON), Osaka-Sayama, Japan.
Gut Liver. 2024 Mar 15;18(2):338-347. doi: 10.5009/gnl220521. Epub 2023 May 11.
BACKGROUND/AIMS: High-grade pancreatic intraepithelial neoplasia and invasive pancreatic ductal adenocarcinoma ≤10 mm are targets for early detection of pancreatic cancer. However, their imaging characteristics are unknown. We aimed to identify endoscopic ultrasound findings for the detection of these lesions.
Patients diagnosed with high-grade pancreatic intraepithelial neoplasia (n=29), pancreatic ductal adenocarcinoma ≤10 mm (n=11) (who underwent surgical resection), or benign main pancreatic duct stenosis (n=20) between January 2014 and January 2021 were retrospectively included. Six features differentiating these lesions were examined by endoscopic ultrasonography: main pancreatic duct stenosis, upstream main pancreatic duct dilation, hypoechoic areas surrounding the main pancreatic duct irregularities (mottled areas without demarcation or round areas with demarcation), branch duct dilation, prominent lobular segmentation, and atrophy. Interobserver agreement was assessed by two independent observers.
Hypoechoic areas surrounding the main pancreatic duct irregularities were observed more frequently in high-grade pancreatic intraepithelial neoplasia (82.8%) and pancreatic ductal adenocarcinoma ≤10 mm (90.9%) than in benign stenosis (15.0%) (p<0.001). High-grade pancreatic intraepithelial neoplasia exhibited mottled hypoechoic areas more frequently (79.3% vs 18.9%, p<0.001), and round hypoechoic areas less frequently (3.4% vs 72.7%, p<0.001), than pancreatic ductal adenocarcinoma ≤10 mm. The sensitivity and specificity of hypoechoic areas for differentiating high-grade pancreatic intraepithelial neoplasia, pancreatic ductal adenocarcinoma ≤10 mm, and benign stenosis were both 85.0%, with moderate interobserver agreement.
The hypoechoic areas surrounding main pancreatic duct irregularities on endoscopic ultrasound may differentiate between high-grade pancreatic intraepithelial neoplasia, pancreatic ductal adenocarcinoma ≤10 mm, and benign stenosis (Trial Registration: UMIN Clinical Trials Registry (UMIN000044789).
背景/目的：高级别胰腺上皮内瘤变和侵袭性胰腺导管腺癌≤10mm 是胰腺癌早期检测的目标。然而，它们的影像学特征尚不清楚。我们旨在确定内镜超声检查对这些病变的检测结果。
回顾性纳入 2014 年 1 月至 2021 年 1 月期间诊断为高级别胰腺上皮内瘤变（n=29）、胰腺导管腺癌≤10mm（n=11）（行手术切除）或良性主胰管狭窄（n=20）的患者。通过内镜超声检查检查了六个区分这些病变的特征：主胰管狭窄、上游主胰管扩张、主胰管不规则周围低回声区（无边界的斑驳区域或有边界的圆形区域）、分支胰管扩张、明显的小叶分段和萎缩。由两位独立观察者评估观察者间一致性。
高级别胰腺上皮内瘤变（82.8%）和胰腺导管腺癌≤10mm（90.9%）中观察到主胰管不规则周围低回声区的频率明显高于良性狭窄（15.0%）（p<0.001）。高级别胰腺上皮内瘤变更常表现为斑驳的低回声区（79.3% vs 18.9%，p<0.001），而较少出现圆形低回声区（3.4% vs 72.7%，p<0.001）。低回声区鉴别高级别胰腺上皮内瘤变、胰腺导管腺癌≤10mm 和良性狭窄的敏感性和特异性均为 85.0%，观察者间一致性中等。
内镜超声检查主胰管不规则周围低回声区可能有助于区分高级别胰腺上皮内瘤变、胰腺导管腺癌≤10mm 和良性狭窄（试验注册：UMIN 临床研究注册（UMIN000044789））。
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