Diagnosis of mucin-producing tumor of the pancreas by balloon-catheter endoscopic retrograde pancreatography--compression study.
Diagnosis of mucin-producing tumor of the pancreas by balloon-catheter endoscopic retrograde pancreatography--compression study.
复制标题
通过球囊导管内窥镜逆行胰腺造影-压迫研究诊断胰腺产生粘蛋白的肿瘤。
作者：
K. Maeshiro;Y. Nakayama;Y. Yasunami;K. Furuta;Seiyo Ikeda
产生粘液的胰腺肿瘤(MPPT)的治疗方法仍然存在争议，因为它不仅包括恶性病变，也包括良性病变。本研究的目的是根据改良的内窥镜逆行胰腺造影方法，即球囊-导管逆行胰管加压检查(BALBLE-ERP-CS)和超声内窥镜检查(EUS)并与组织学检查相对照，对连续53例MPPT进行定性和良、恶性鉴别。男性37例，女性16例，中位年龄63±11岁(平均+/-SD)。所有病例均行球囊ERP-CS检查，所得图像分为两型：主管型和支管型。后者又分为A型和B型。A型支管仅表现为囊性扩张。如果位于囊肿下游的主胰管扩张超过5 mm，则被归类为B型分支胰管。组织学诊断为肿瘤17例(89%)，其中癌13例，腺瘤4例。支管A型均诊断为增生症。B型分支管23例，其中癌7例，腺瘤8例，增生性病变8例。在主管型、良恶性中，球囊ERP-CS诊断的敏感度为100%，特异度为40%，准确度为84%；在支管型中，灵敏度为73%，特异度为86%，准确度为82%。在EUS上，发现囊内肿瘤的大小，相对于最大直径和高度，与恶性程度有很好的相关性。所有大于20 mm的肿瘤(n=35)均为癌。这些结果表明，当球囊ERP-CS发现主胰管扩张时，以及在没有主胰管扩张的病例中，当球囊ERP-CS和EUS发现囊内直径大于10 mm的结节状病变时，MPPT对肿瘤具有高度的提示意义。我们目前的手术患者管理策略是：主管型患者和支管型患者在EUS中发现结节状缺损，且EUS的高度超过10 mm时应手术治疗。对其他无主胰管扩张的支管型患者行球囊ERP-CS随访。
The procedure of choice for the treatment of mucin-producing pancreatic tumor (MPPT) remains controversial, since it includes not only malignant but also benign lesions. The purpose of the present study was to characterize 53 consecutive cases of MPPT and to elucidate the characteristics of benign or malignant MPPT according to the findings of an improved method of endoscopic retrograde pancreatography (ERP), namely balloon-catheter ERP-compression study (balloon ERP-CS), as well as endoscopic ultrasonography (EUS), in comparison with a histological examination. There were 37 male and 16 female cases with a median age of 63+/-11 (mean+/-SD). The balloon ERP-CS was performed in all cases, and the obtained pancreatograms were classified into two types: Main Duct type and Branch Duct type. The latter was further divided into subtypes A and B. The Branch Duct A type showed only cystic dilatation of the branch duct. If the main pancreatic duct downstream to a cyst showed more than a 5 mm dilatation, this was classified as a Branch Duct B type. Seventeen out of 19 Main duct types (89%) were histologically diagnosed as neoplasms including 13 lesions of cancer and 4 of adenoma. All the Branch Duct A type cases were diagnosed as hyperplasias. 23 Branch Duct B type cases contained 7 cancers, 8 adenomas, and 8 hyperplasias. In the Main Duct type, benign or malignant, the diagnostic ability of balloon ERP-CS was calculated as sensitivity 100%, specificity 40%, and accuracy 84%; in the Branch Duct type, sensitivity 73%, specificity 86%, and accuracy 82%. On EUS, it was found that the size of the tumor in the cyst, with respect to the maximum diameter as well as height, correlated well with the grade of malignancy. All tumors (n=35) greater than 20 mm in diameter were found to be cancerous. These findings indicate that the MPPT is highly suggestive of neoplasms when the dilatation of the main pancreatic duct is detected by balloon ERP-CS and when, in a case without dilatation of the main pancreatic duct, a nodular lesion greater than 10 mm in diameter is identified in the cyst by balloon ERP-CS as well as EUS. Our current patient management strategy for operations is as follows: Main Duct type patients and Branch Duct type patients with a nodular defect detected by balloon ERP-CS and with an elevation of more than 10 mm in EUS should have an operation. Other Branch Duct type patients without main pancreatic duct dilatation are followed up by balloon ERP-CS.