Mukai H, Yasuda K, Nakajima M
Dept. of Gastroenterology, Yodogawa Christian Hospital, Osaka, Japan.
Endoscopy. 1998 Aug;30 Suppl 1:A99-102. doi: 10.1055/s-2007-1001486.
Although mucin producing tumors of the pancreas have been recently recognized as premalignant or malignant neoplasms, their diagnosis and management have been undetermined as yet. The aim of this study was to evaluate the capability of intraductal ultrasonography (IDUS) and peroral pancreatoscopy (PPS) in the differential diagnosis of mucin-producing tumors compared to that of other diagnostic tools.
From 1986 to 1997, 31 patients with mucin-producing tumors of the pancreas underwent surgery.
Histologically, in patients with adenocarcinoma, papillary tumorous lesions within the pancreatic ducts were 3 mm or more in maximum height. The detection rates for such lesions were 29% with US, 21% with CT, 86% with EUS, 100% with IDUS and 83% with PPS. In patients with adenocarcinoma, PPS revealed taller papillary lesions with redness and/or capillary vessels. Biopsy and cytology during ERCP and under PPS direct vision had a sensitivity of about 60 % in the differential diagnosis between malignancy and benign diseases.
Mucin-producing tumors of the pancreas with papillary tumorous lesions of 3 mm or more in maximum height should be considered as adenocarcinomas. The combined use of IDUS and PPS with biopsy and cytology is now considered the best for the differential diagnosis of mucin-producing tumors of the pancreas.
尽管胰腺黏液生成性肿瘤最近已被确认为癌前或恶性肿瘤，但其诊断和治疗方法尚未确定。本研究的目的是评估与其他诊断工具相比，导管内超声检查（IDUS）和经口胰管镜检查（PPS）在胰腺黏液生成性肿瘤鉴别诊断中的能力。
1986年至1997年，31例胰腺黏液生成性肿瘤患者接受了手术。
组织学检查显示，腺癌患者胰管内乳头状肿瘤性病变最大高度为3毫米或更高。这些病变的检出率分别为：超声检查29%，CT检查21%，内镜超声检查（EUS）86%，IDUS检查100%，PPS检查83%。在腺癌患者中，PPS显示出更高的乳头状病变，伴有发红和/或毛细血管。在ERCP期间以及PPS直视下进行活检和细胞学检查，在恶性与良性疾病鉴别诊断中的敏感性约为60%。
最大高度为3毫米或更高的乳头状肿瘤性病变的胰腺黏液生成性肿瘤应被视为腺癌。目前认为，IDUS和PPS联合活检和细胞学检查是胰腺黏液生成性肿瘤鉴别诊断的最佳方法。
