Cellier C, Cuillerier E, Palazzo L, Rickaert F, Flejou J F, Napoleon B, Van Gansbeke D, Bely N, Ponsot P, Partensky C, Cugnenc P H, Barbier J P, Devière J, Cremer M
Department of Gastroenterology, Laennec Hospital, Paris, France.
Gastrointest Endosc. 1998 Jan;47(1):42-9. doi: 10.1016/s0016-5107(98)70297-4.
Few data are available on the accuracy of preoperative imaging or on long-term outcome after surgery for intraductal papillary and mucinous tumors of the pancreas. The aims of this study were to assess the following: (1) the accuracy of preoperative computed tomography, endoscopic retrograde pancreatography, and endoscopic ultrasonography for determination of tumor invasion and pancreatic extension as compared with surgical findings; (2) the long-term outcome after surgery.
Forty-seven patients who underwent surgery between 1980 and 1995 for pathologically diagnosed intraductal papillary and mucinous tumors were included in this study. The findings of available computed tomography (n = 25), endoscopic retrograde pancreatography (n = 29), and endoscopic ultrasonography (n = 21) were reviewed by experienced clinicians blinded to pathologic diagnosis to assess tumor invasion and pancreatic extension. Pathologic specimens were reviewed by experienced pathologists. Postoperative follow-up data were analyzed.
Histologic features of invasive carcinoma were found in 43% of patients, severe dysplasia in 21%, and mild or moderate dysplasia in 36%. The overall accuracy of computed tomography, endoscopic retrograde pancreatography, and endoscopic ultrasonography in distinguishing between invasive and noninvasive tumors were, respectively, 76%, 79%, and 76%. The overall 3-year disease-free survival rate was 63%, but it was 21% among patients with invasive carcinoma at surgery (p < 0.001).
This study emphasizes the need for early surgical resection in patients with suspected intraductal papillary and mucinous tumors of the pancreas because of the high frequency of invasive carcinoma and the inadequacy of preoperative imaging for assessing malignancy.
关于胰腺导管内乳头状黏液性肿瘤术前影像学检查的准确性以及手术后的长期预后，目前可用的数据较少。本研究的目的是评估以下内容：（1）与手术结果相比，术前计算机断层扫描、内镜逆行胰胆管造影和内镜超声检查在确定肿瘤侵犯和胰腺扩展方面的准确性；（2）手术后的长期预后。
本研究纳入了1980年至1995年间因病理诊断为胰腺导管内乳头状黏液性肿瘤而接受手术的47例患者。由对病理诊断不知情的经验丰富的临床医生回顾现有的计算机断层扫描（n = 25）、内镜逆行胰胆管造影（n = 29）和内镜超声检查（n = 21）的结果，以评估肿瘤侵犯和胰腺扩展情况。由经验丰富的病理学家对病理标本进行复查。对术后随访数据进行分析。
43%的患者发现有浸润性癌的组织学特征，21%为重度不典型增生，36%为轻度或中度不典型增生。计算机断层扫描、内镜逆行胰胆管造影和内镜超声检查在区分浸润性和非浸润性肿瘤方面的总体准确率分别为76%、79%和76%。总体3年无病生存率为63%，但手术时患有浸润性癌的患者中这一比例为21%（p < 0.001）。
本研究强调，由于胰腺导管内乳头状黏液性肿瘤患者浸润性癌的发生率高且术前影像学检查不足以评估恶性程度，因此对疑似患者需要尽早进行手术切除。
