El-Nady Mohammed A, Ead Khalid A, Haridy Mustafa A, Shaheen Nour, Nashwan Abdulqadir J, Abdelwahid Saad R, Mohammed Mohammed F, Mohamed Omran, Sawy Safwat S, Abdelrazzak Emad, Hassan Amro M
Medicine, Cairo University, Cairo, EGY.
Hepatology, Gastroenterology, and Infectious Diseases, Al-Azhar University, Assiut, EGY.
Cureus. 2024 Feb 10;16(2):e53988. doi: 10.7759/cureus.53988. eCollection 2024 Feb.
Introduction Computed tomography (CT) of the abdomen with contrast stands as the gold standard for assessing pancreatic cancer, encompassing both staging and vascular analysis. However, not all patients are suitable candidates for contrast-enhanced CT (CECT) scans due to factors such as contrast agent allergies, pregnancy, renal impairment, radiation risks, and limited tissue sampling capability in CECT scans of the abdomen. In light of these challenges, this study evaluated the diagnostic capabilities of endoscopic ultrasound (EUS) compared to CECT for staging and vascular assessment of pancreatic cancer. Methods Fifty patients diagnosed with pancreatic cancer underwent evaluations using both CECT scans and EUS, focusing on staging and vascular invasion assessment. Vascular evaluation was carried out using a categorization system based on EUS findings, classifying them into three types based on the tumor-vessel relationship: Type 1 indicating clear invasion or encasement of a vessel by a tumor or contact with a vessel wall exceeding 180 degrees, Type 2 representing abutment, wherein a tumor contacts a vessel wall but at an angle less than 180 degrees, and Type 3 implying clear non-invasion, where a discernible distance exists between a tumor and a vessel. In this categorization, Type 1 and Type 2 indicated signs of vascular invasion, while Type 3 indicated vascular non-invasion. These findings were subsequently compared to the results from CECT scans. The endoscopist performing EUS was blinded to the CT outcomes prior to the examination. Results Regarding pancreatic cancer staging, EUS exhibited remarkable sensitivity, specificity, and accuracy rates of 100% according to the T criterion.As for vascular invasion assessment, EUS demonstrated sensitivity, specificity, and accuracy of 100%, 95.93%, and 96%, respectively, for venous invasion. For arterial invasion, the figures were 95.65% sensitivity, 100% specificity, and an overall accuracy of 99.5%. Conclusion EUS is an effective modality for evaluating both staging and vascular invasion in pancreatic cancer, boasting exceptional sensitivity, specificity, and accuracy rates. The findings are robust enough to consider EUS a viable alternative to CT scans in evaluation, with the added advantage of EUS offering tissue sampling capability.
引言 腹部增强计算机断层扫描（CT）是评估胰腺癌的金标准，包括分期和血管分析。然而，由于造影剂过敏、怀孕、肾功能损害、辐射风险以及腹部增强CT扫描组织取样能力有限等因素，并非所有患者都适合进行增强CT（CECT）扫描。鉴于这些挑战，本研究评估了内镜超声（EUS）与CECT相比在胰腺癌分期和血管评估方面的诊断能力。
方法 50例诊断为胰腺癌的患者接受了CECT扫描和EUS评估，重点是分期和血管侵犯评估。血管评估基于EUS结果使用分类系统进行，根据肿瘤与血管的关系将其分为三种类型：1型表示肿瘤明显侵犯或包绕血管或与血管壁接触超过180度，2型表示毗邻，即肿瘤与血管壁接触但角度小于180度，3型表示明显无侵犯，即肿瘤与血管之间存在可辨别的距离。在此分类中，1型和2型表示血管侵犯迹象，而3型表示血管无侵犯。随后将这些结果与CECT扫描结果进行比较。进行EUS检查的内镜医师在检查前对CT结果不知情。
结果 在胰腺癌分期方面，根据T标准，EUS显示出100%的显著敏感性、特异性和准确率。在血管侵犯评估方面，EUS对静脉侵犯的敏感性、特异性和准确率分别为100%、95.93%和96%。对于动脉侵犯，敏感性为95.65%，特异性为100%，总体准确率为99.5%。
结论 EUS是评估胰腺癌分期和血管侵犯的有效方法，具有出色的敏感性、特异性和准确率。这些结果足以证明EUS在评估中是CT扫描的可行替代方法，此外EUS还具有组织取样能力这一优势。
