Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan.
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Pancreatology. 2023 Aug;23(5):550-555. doi: 10.1016/j.pan.2023.05.010. Epub 2023 May 25.
BACKGROUND/OBJECTIVES: The detection of malignancy is a major concern in the management of intraductal papillary mucinous neoplasm (IPMN). The height of the mural nodule (MN), estimated using endoscopic ultrasound (EUS) and computed tomography (CT), has been considered crucial for predicting malignant IPMN. Currently, whether surveillance using CT or EUS alone is sufficient for detecting MNs remains unclear. This study aimed to compare the ability of CT and EUS to detect MNs in IPMN.
This multicenter, retrospective observational study was conducted in 11 Japanese tertiary institutions. Patients who underwent surgical resection of IPMN with MN after CT and EUS examinations were eligible to participate. The MN detection rates between CT and EUS were examined.
Two-hundred-and-forty patients who underwent preoperative EUS and CT had pathologically confirmed MNs. The MN detection rates of EUS and CT were 83% and 53%, respectively (p < 0.001). Additionally, the MN detection rate of EUS was significantly higher than that of CT regardless of morphological type (76% vs. 47% in branch-duct-type IPMN; 90% vs. 54% in mixed IPMN; 98% vs. 56% in main-duct-type IPMN; p < 0.001). Further, pathologically confirmed MNs ≥5 mm were more frequently observed on EUS than on CT (95% vs. 76%, p < 0.001).
EUS was superior to CT for the detection of MN in IPMN. EUS surveillance is essential for the detection of MNs.
背景/目的：在处理导管内乳头状黏液性肿瘤（IPMN）时，恶性肿瘤的检测是一个主要关注点。使用内镜超声（EUS）和计算机断层扫描（CT）估计的壁结节（MN）高度对于预测恶性 IPMN 至关重要。目前，单独使用 CT 或 EUS 进行监测是否足以检测 MN 尚不清楚。本研究旨在比较 CT 和 EUS 检测 IPMN 中 MN 的能力。
这是一项在 11 家日本三级医疗机构进行的多中心、回顾性观察性研究。符合条件的患者为在 CT 和 EUS 检查后接受 MN 手术切除的 IPMN 患者。检查了 CT 和 EUS 之间 MN 的检出率。
240 名接受术前 EUS 和 CT 检查的患者经病理证实存在 MN。EUS 和 CT 的 MN 检出率分别为 83%和 53%（p<0.001）。此外，EUS 的 MN 检出率明显高于 CT，无论形态类型如何（分支型 IPMN 为 76% vs. 47%；混合型 IPMN 为 90% vs. 54%；主胰管型 IPMN 为 98% vs. 56%；p<0.001）。此外，在 EUS 上观察到的病理证实的 MN≥5mm 比在 CT 上更频繁（95% vs. 76%，p<0.001）。
EUS 优于 CT 用于检测 IPMN 中的 MN。EUS 监测对于 MN 的检测至关重要。
