Value of ultrasound biomicroscopy in assessment of small masses at medial canthal region
Value of ultrasound biomicroscopy in assessment of small masses at medial canthal region
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超声生物显微镜检查在内眦区小肿块评估中的价值
DOI：
10.1007/s00417-019-04252-y
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发表时间：
2019-04-01
影响因子：
2.7
通讯作者：
Yuan，Yifei
中科院分区：
文献类型：
--
作者：
Chen，Qian;Ma，Ruiqi;Yuan，Yifei
目的常规的影像学检查方法对泪道引流系统及其周围组织的详细结构显示不够灵敏。我们的研究旨在探讨超声生物显微镜（UBM）在评估内眦区小肿块中的实用性，并将UBM与传统成像技术的性能进行比较。MethodsWe前瞻性招募了2017年6月至2018年10月内眦区（上LDS定位区域）小肿块（长轴< 1 cm）的病例。UBM ±彩色多普勒血流成像（CDFI）和常规成像技术（计算机断层扫描、磁共振成像和泪囊造影术）由4名独立医生进行。采用Cohen 'sKappa检验对结果进行金标准分析，包括LDS通畅性、肿块位置和推定诊断。相应的金标准是注射器和泪囊造影，术中发现，病理/经验diagnosis. Results 72例被招募，其中20例LDS病变和52例ST病变。女性（优势比7.14）和年龄≥ 37岁（优势比9.80）是LDS病变的危险因素，15-25岁（优势比9.17）是炎性ST段病变的危险因素。在LDS通畅性方面，UBM结果对于检测囊前阻塞是可靠的（kappa = 0.920），但对于囊内和囊后阻塞是不可靠的（kappa = 0.106）。在肿块定位方面，UBM（kappa = 0.766）在筛选ST段病变方面优于传统技术（泪囊造影除外），敏感性为93.8%，特异性为83.3%。在诊断方面，UBM（kappa = 0.882）优于常规技术（磁共振成像除外），以区分囊肿和结节，敏感性为93.8%，特异性为94.4%。值得注意的是，UBM + CDFI在筛选炎性病变（kappa = 0.926 vs kappa = 0.689）和LDS相邻病变（kappa = 0.815 vs kappa = 0.673）时的性能优于UBM，导致两种检测项目的敏感性为91.7%，特异性为100%。如果深部病变（在泪囊区）被排除，UBM检测炎性病变的可靠性（kappa = 0.915）和LDS邻近病变（kappa = 0.770）改善，敏感性分别为90.0%和88.9%，特异性分别为100.0%和92.7%，结论UBM是一种有价值的工具，可以评估内眦区浅表肿块的囊前阻塞，肿块的位置，试验注册本研究在中国临床试验注册中心网站注册，注册号为 ChiCTR 1800018956 .
PurposeConventional imaging techniques are not sensitive enough to reveal detailed structures of lacrimal drainage system (LDS) and its surrounding tissue (ST). Our study aimed to explore utility of ultrasound biomicroscopy (UBM) in assessment of small masses at the medial canthal region and compare performance of UBM with conventional imaging techniques.MethodsWe prospectively recruited cases with small mass (long axis < 1 cm) at the medial canthal region (upper LDS-located area) from June 2017 to October 2018. UBM ± color Doppler flow imaging (CDFI) and conventional imaging techniques (computed tomography, magnetic resonance imaging, and dacryocystography) were conducted by four independent practitioners. Results were analyzed against gold standards with Cohen’s kappa test in three aspects including LDS patency, mass location, and presumptive diagnosis. Corresponding gold standards were syringe and dacryocystography, intraoperative findings, and pathological/empirical diagnosis.ResultsSeventy-two cases were recruited, including 20 cases of LDS lesions and 52 cases of ST lesions. Female (odds ratio 7.14) and age ≥ 37 (odds ratio 9.80) were risk factors for LDS lesion, and age range of 15–25 (odds ratio 9.17) was a risk factor for inflammatory ST lesion. In terms of LDS patency, UBM results were reliable for the detection of pre-saccal obstruction (kappa = 0.920), but were not reliable for intra-saccal and post-saccal obstruction (kappa = 0.106). In terms of mass location, the UBM (kappa = 0.766) performed better than conventional techniques (except for dacryocystography) to sort out ST lesions, with sensitivity of 93.8% and specificity of 83.3%. In terms of diagnosis, the UBM (kappa = 0.882) outweighed conventional techniques (except for magnetic resonance imaging) to distinguish cysts from nodules, with sensitivity of 93.8% and specificity of 94.4%. Notably, the UBM + CDFI achieved better performance than the UBM when screen out inflammatory lesions (kappa = 0.926 vs kappa = 0.689) and LDS-adjacent lesions (kappa = 0.815 vs kappa = 0.673), resulting in sensitivity of 91.7% and specificity of 100% for both testing items. If deep lesions (at the lacrimal sac–harbored area) were excluded, UBM reliability to detect inflammatory lesions (kappa = 0.915) and LDS-adjacent lesions (kappa = 0.770) improved, achieving sensitivity of 90.0% and 88.9%, and specificity of 100.0% and 92.7%, respectively.ConclusionsThe UBM is a valuable tool to assess superficial masses at the medial canthal region regarding pre-saccal obstruction, mass location, and presumptive diagnosis.Trial registrationThis work was registered on Chinese Clinical Trial Registry website with registration number ChiCTR1800018956 .