Factors associated with misdiagnosis of preoperative endoscopic ultrasound in patients with pancreatic cystic neoplasms undergoing surgical resection
Factors associated with misdiagnosis of preoperative endoscopic ultrasound in patients with pancreatic cystic neoplasms undergoing surgical resection
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胰腺囊性肿瘤手术切除患者术前超声内镜误诊的相关因素
DOI：
10.1007/s10396-022-01205-7
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发表时间：
2022
期刊：
影响因子：
1.8
通讯作者：
Eizaburo Ohno
中科院分区：
文献类型：
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作者：
Satoh T;Takiguchi H;Uojima H;Kubo M;Tanaka C;Yokoyama F;Wada N;Miyazaki K;Hidaka H;Kusano C;Kuwana M;Horie R;Eizaburo Ohno
目的胰腺囊性病变包括各种类型的囊肿。正确的术前诊断是避免不必要的良性囊肿手术的关键。在这项研究中，我们的目的是确定术前内镜超声（EUS）成像和PCLs的临床病理结果与误诊的相关因素。MethodsThis研究包括302例手术切除的PCLs谁进行术前EUS。对术前EUS所见进行重新评估，并与病理诊断进行比较。结果术前诊断为导管内乳头状黏液性肿瘤（IPMN）的213例患者中，有1例为乳腺导管内乳头状黏液性肿瘤（IPMN），其余均为乳腺导管内乳头状黏液性肿瘤（IPMN）粘液性囊性肿瘤（MCN）33例胰腺癌合并囊变3例（1.0%）。47例（15.6%）患者术前和术后诊断不一致。根据病理诊断，术前EUS检查的敏感性分别为IPMN 97.6%（206/211），MCN 90.0%（18/19），囊性变87.1%（27/31），SN 15.4%（2/13）。多变量分析显示，主胰管（MPD）沟通（−）（比值比（OR），4.54; 95%置信区间（CI）1.29-15.9），蜂窝状结构（+）（OR，14.7; 95% CI 2.61-83.3），MPD尺寸≥ 2 mm（OR，16.3; 95% CI 3.93-67.6）结论对于术前EUS提示MCN和实体瘤囊变的病例，对于具有蜂窝状结构的PCL，应考虑采用多模态诊断或采用EUS引导细针穿刺进行液体分析。
PurposePancreatic cystic lesions (PCLs) include various types of cysts. Accurate preoperative diagnosis is essential to avoid unnecessary surgery on benign cysts. In this study, we aimed to identify the factors associated with misdiagnosis in preoperative endoscopic ultrasound (EUS) imaging and clinicopathological findings for PCLs.MethodsThis study included 302 surgically resected patients with PCLs who underwent preoperative EUS. The preoperative EUS findings were re-evaluated and compared with the pathological diagnosis. Additionally, the factors associated with misdiagnosis of PCLs were investigated by multivariate analysis.ResultsThe preoperative diagnoses of PCLs were intraductal papillary mucinous neoplasm (IPMN) in 213 patients (70.5%), mucinous cystic neoplasm (MCN) in 33 patients (10.9%), serous neoplasm (SN) in 7 patients (2.3%), cystic degeneration cyst of solid tumor in 46 patients (15.2%), and pancreatic cancer with cystic degeneration in three patients (1.0%). A discrepancy between preoperative and postoperative diagnosis was found in 47 patients (15.6%). Based on the pathological diagnosis, the sensitivity of preoperative EUS imaging was IPMN 97.6% (206/211), MCN 90.0% (18/19), cystic degeneration 87.1% (27/31), and SN 15.4% (2/13). Multivariate analysis revealed that main pancreatic duct (MPD) communication ( − ) (odds ratio (OR), 4.54; 95% confidence interval (CI) 1.29–15.9), honeycomb-like structure ( +) (OR, 14.7; 95% CI 2.61–83.3), and MPD size ≦ 2 mm (OR, 16.3; 95% CI 3.93–67.6) were independently associated with misdiagnosis.ConclusionFor cases in which MCN and cystic degeneration of solid tumor are presumed based on preoperative EUS imaging and cases with PCLs with a honeycomb-like structure, diagnosis with multimodalities or fluid analysis with EUS-guided fine-needle aspiration should be considered.