Endoscopic ultrasound-guided fine needle aspiration and multidetector spiral CT in the diagnosis of pancreatic cancer
Endoscopic ultrasound-guided fine needle aspiration and multidetector spiral CT in the diagnosis of pancreatic cancer
复制标题
DOI：
10.1111/j.1572-0241.2004.04177.x
复制
发表时间：
2004-05-01
影响因子：
9.8
通讯作者：
Ho, L
中科院分区：
文献类型：
--
作者：
Agarwal, B;Abu-Hamda, E;Ho, L
前言：超声内窥镜(EUS)现已成为诊断和分期胰腺癌的一种有价值的影像检查方法。但是，随着最近螺旋CT扫描仪的显著改进，特别是更高的分辨率和重建3D图像的能力，螺旋CT现在越来越多地被认为是更好的胰腺癌分期。然而，关于疑似胰腺癌患者的最佳诊断测试或组合测试的争论仍在继续。螺旋CT比EUS-FNA更容易获得，因此使用更频繁。方法：我们对2000年11月至2001年11月间因临床怀疑胰腺癌而行EUS和EUS-FNA检查的8：1患者进行了回顾性评估。所有患者均行螺旋CT扫描，采用多层螺旋CT进行胰腺多期扫描。结果：螺旋CT、EUS和EUS-FNA对胰腺癌的诊断准确率分别为74%(n=60/81，CI 63~83%)、94%(n=76/81，CI 87~98%)和88%(n=73/81，CI 81~96%)。在螺旋CT未发现肿块的患者中，EUS和EUS-FNA对胰腺肿瘤的诊断准确率为92%(n=23/25，CI 74~99%)。无论临床表现如何(NPV 100%n=5/5，CI 48-100%)，EUS上无局灶性“肿块”病变可可靠地排除胰腺癌。EUS-FNA对梗阻性黄疸和胆管狭窄的阴性预测值仅为22%(n=2/9，CI为3~60%)。而对于初发无梗阻性黄疸的患者，EUS-FNA诊断准确率高(准确率97%，n=33/34，CI 85~100%)，并能可靠地排除恶性病变(NPV 89%，n=8/9，CI 52~100%)。EUS-NA标本细胞学检查对EUS显示的可疑病变的诊断准确率为89%。结论：EUS结合FNA可作为较新的高分辨率多层螺旋CT对可疑胰腺癌患者的诊断价值的补充。
INTRODUCTION: Endoscopic ultrasound (EUS) is now established as a valuable imaging test for diagnosing and staging pancreatic cancer. But, with significant recent improvements in spiral CT scanners, particularly higher resolution and ability to reconstruct 3D images, spiral CT is now increasingly accepted as being better for pancreatic cancer staging. The debate continues, however, about the best diagnostic test or combination of tests in patients with suspected pancreatic cancer. Spiral CT is more readily available than EUS-FNA and, therefore, more frequently used. In this study, we evaluated the use of EUS-FNA in conjunction with spiral CT for suspected pancreatic cancer.METHODS: We retrospectively evaluated 8:1 consecutive patients who underwent EUS and EUS-FNA for clinical suspicion of a pancreatic cancer from November 2000 to November 2001. All patients had spiral CT with a multiphasic pancreatic protocol using multidetector spiral CT scanners. In all patients, EUS-FNA and spiral CT examinations were performed less than 3 wk apart.RESULTS: Overall, the accuracy of spiral CT, EUS, and EUS-FNA was 74% (n = 60/81, CI 63-83%), 94% (n = 76/81, CI 87-98%), and 88% (n = 73/81, CI 81-96%), respectively, for diagnosing pancreatic cancer. In patients without an identifiable mass on spiral CT, the diagnostic accuracy of EUS and EUS-FNA for pancreatic tumors was 92% (n = 23/25, CI 74-99%). Absence of a focal "mass" lesion on EUS reliably excluded pancreatic cancer irrespective of clinical presentation (NPV 100% n = 5/5, CI 48-100%). The negative predictive value of EUS-FNA was only 22% (n = 2/9, CI 3-60%) in patients with obstructive jaundice and biliary stricture. However, in patients without obstructive jaundice at initial presentation, EUS-FNA was highly accurate (accuracy 97%, n = 33/34, CI 85-100%) and was reliable for ruling out malignancy (NPV 89%, n = 8/9, CI 52-100%). Cytologic assessment of EUS-NA specimens was 89% accurate for identifying malignancy in suspicious lesions visualized on EUS.CONCLUSIONS: The EUS with FNA can be a valuable adjunct to newer high-resolution multidetector spiral CT for diagnostic evaluation of patients with suspected pancreatic cancer.