Contrast-enhanced harmonic endoscopic ultrasonography for assessment of lymph node metastases in pancreatobiliary carcinoma
Contrast-enhanced harmonic endoscopic ultrasonography for assessment of lymph node metastases in pancreatobiliary carcinoma
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DOI：
10.3748/wjg.v22.i12.3381
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发表时间：
2016-03-28
影响因子：
4.3
通讯作者：
Kudo, Masatoshi
中科院分区：
文献类型：
--
作者：
Miyata, Takeshi;Kitano, Masayuki;Kudo, Masatoshi
目的：目的：探讨超声内镜下谐波超声造影（CH-EUS）对胰胆管癌淋巴结转移的诊断价值。方法：收集2009年6月至2012年1月期间经标准EUS检查后发现淋巴结转移的疑似胰胆管癌患者。在主要分析中，纳入了成功进行EUS-细针穿刺（FNA）的患者。通过几个标准EUS变量（短轴和长轴长度、形状、边缘特征和回声）、彩色多普勒EUS变量[中心结内血管（CIV）存在]和CH-EUS变量（不均匀/均匀增强模式）评估淋巴结。计算相对于EUS-FNA的诊断准确性。在第二次分析中，N期诊断准确性CH-EUS进行了比较，EUS-FNA在接受手术切除patients who received surgical surgery.RESULTS：109例患者（143个淋巴结）符合标准。短轴临界值>= 13 mm预测恶性肿瘤的敏感性和特异性分别为72%和85%。长轴截止值≥ 20 mm时，这些值分别为72%和63%，圆形变量分别为62%和75%，锐缘变量分别为81%和30%，低回声变量分别为66%和61%，CIV缺失变量分别为70%和72%，不均匀CH-EUS增强变量分别为83%和91%。除短轴截断值外，CH-EUS的准确性均高于标准EUS和彩色多普勒EUS。值得注意的是，3例患者排除，因为EUS-FNA失败是正确的N分期CH-EUS.CONCLUSION：CH-EUS补充标准和彩色多普勒EUS和EUS-FNA评估淋巴结转移。
AIM: To assess the usefulness of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for lymph node metastasis in pancreatobiliary carcinoma.METHODS: All patients suspected of pancreatobiliary carcinoma with visible lymph nodes after standard EUS between June, 2009 and January, 2012 were enrolled. In the primary analysis, patients with successful EUS-fine needle aspiration (FNA) were included. The lymph nodes were assessed by several standard EUS variables (short and long axis lengths, shape, edge characteristic and echogenicity), color Doppler EUS variable [central intranodal blood vessel (CIV) presence] and CH-EUS variable (heterogeneous/homogeneous enhancement patterns). The diagnostic accuracy relative to EUS-FNA was calculated. In the second analysis, N-stage diagnostic accuracy of CH-EUS was compared with EUS-FNA in patients who underwent surgical resection.RESULTS: One hundred and nine patients (143 lymph nodes) fulfilled the criteria. The short axis cutoff >= 13 mm predicted malignancy with a sensitivity and specificity of 72% and 85%, respectively. These values were 72% and 63% for the long axis cut-off >= 20 mm, 62% and 75% for the round shape variable, 81% and 30% for the sharp edge variable, 66% and 61% for the hypoechogenicity variable, 70% and 72% for the CIV-absent variable, and 83% and 91% for the heterogeneous CH-EUS-enhancement variable, respectively. CH-EUS was more accurate than standard and color Doppler EUS, except the short axis cut-off. Notably, three patients excluded because of EUS-FNA failure were correctly N-staged by CH-EUS.CONCLUSION: CH-EUS complements standard and color Doppler EUS and EUS-FNA for assessment of lymph node metastases.