Koshita Shinsuke, Noda Yutaka, Kanno Yoshihide, Ogawa Takahisa, Kusunose Hiroaki, Sakai Toshitaka, Yonamine Keisuke, Miyamoto Kazuaki, Kozakai Fumisato, Okano Haruka, Matsuoka Yuto, Hosokawa Kento, Sumiya Hidehito, Oikawa Masaya, Tsuchiya Takashi, Sawai Takashi, Ito Kei
Gastroenterology, Public Interest Incorporated Foundation Sendai City Medical Center, Sendai, Japan.
Department of Gastroenterology, Public Interest Incorporated Foundation Sendai City Medical Center, Sendai, Japan.
Endosc Int Open. 2024 Nov 28;12(11):E1401-E1410. doi: 10.1055/a-2452-2919. eCollection 2024 Nov.
Because more than a few patients have intraductal papillary mucinous neoplasms of the pancreas (IPMNs) with mural nodules (MNs) that are benign, clinical plans should be determined by using histocytological specimens especially, for patients with high risk for surgery or with a small MN. This study included 27 patients to evaluate the efficacy of peroral pancreatoscopy using a SpyGlass DS system (POPS-DS) for patients with MN-positive IPMN, mainly focusing on the ability of POPS-DS to detect malignancy. Biopsy specimens obtained under POPS-DS guidance could be used for histological evaluation of all patients with MNs in the main pancreatic duct and 67% of the patients with MNs in the branch ducts, whereas fluid specimens collected during POPS-DS could be used for histocytological evaluation for all patients. For the 13 patients who underwent surgery just after POPS-DS, the sensitivity, specificity, and accuracy of POPS-DS to detect malignancy were 89%, 100%, and 92%, respectively. For the 12 patients who underwent surveillance without surgery, the cumulative 3-year progression rates for nine benign IPMNs and three malignant ones determined using POPS-DS were 0% and 100%, respectively. However, the sensitivity of POPS to detect IPMN epithelium in the resection margin was 20%. Only one patient developed procedure-related pancreatitis (mild). POPS-DS could be used to accurately detect malignancy in patients with MN-positive IPMN. Therefore, histocytological evaluation using POPS-DS can contribute to selection of patients for whom surgery would be appropriate.
由于不少胰腺导管内乳头状黏液性肿瘤（IPMN）合并壁结节（MN）的患者为良性，临床方案的制定应特别依据组织细胞学标本，尤其是对于手术风险高或MN较小的患者。本研究纳入了27例患者，以评估使用SpyGlass DS系统的经口胰管镜检查（POPS-DS）对MN阳性IPMN患者的疗效，主要关注POPS-DS检测恶性肿瘤的能力。在POPS-DS引导下获取的活检标本可用于所有主胰管有MN患者以及67%分支胰管有MN患者的组织学评估，而POPS-DS过程中收集的液体标本可用于所有患者的组织细胞学评估。对于在POPS-DS后立即接受手术的13例患者，POPS-DS检测恶性肿瘤的敏感性、特异性和准确性分别为89%、100%和92%。对于12例未接受手术而进行监测的患者，使用POPS-DS确定的9例良性IPMN和3例恶性IPMN的3年累积进展率分别为0%和100%。然而，POPS检测切除边缘IPMN上皮的敏感性为20%。仅1例患者发生了与操作相关的胰腺炎（轻度）。POPS-DS可用于准确检测MN阳性IPMN患者的恶性肿瘤。因此，使用POPS-DS进行组织细胞学评估有助于选择适合手术的患者。
