Differential Diagnostic and Staging Accuracies of High Resolution Ultrasonography, Endoscopic Ultrasonography, and Multidetector Computed Tomography for Gallbladder Polypoid Lesions and Gallbladder Cancer
Differential Diagnostic and Staging Accuracies of High Resolution Ultrasonography, Endoscopic Ultrasonography, and Multidetector Computed Tomography for Gallbladder Polypoid Lesions and Gallbladder Cancer
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DOI：
10.1097/sla.0b013e3181b5d5fc
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发表时间：
2009-12-01
影响因子：
9
通讯作者：
Kim, Yong-Tae
中科院分区：
文献类型：
--
作者：
Jang, Jin-Young;Kim, Sun-Whe;Kim, Yong-Tae
目的：探讨高分辨率超声(HRUS)对胆囊息肉样病变和胆囊癌的诊断价值，比较超声内窥镜(EUS)、高分辨率超声(HRUS)和多层螺旋CT对胆囊息肉样病变和胆囊癌的鉴别诊断和分期准确性。然而，包括常规超声(US)在内的其他成像方式的最新技术进步允许产生可比较的图像。方法：在这项前瞻性、盲法、对比研究中，共有170名患者被连续纳入这项前瞻性、盲法、对比研究，这些患者的GB息肉样病变超过1厘米，在初次筛查中没有明确的局部侵犯邻近器官的证据。在排除了26名有不适当病史的患者后，144名患者最终入选。所有患者均接受手术切除。结果：144例中良性甲状腺息肉115例(79.8%)，胆囊癌29例(20.2%)。HRUS诊断恶性肿瘤的敏感性为90%，EUS为86%，CT为72%。在评估这些方法预测GB癌侵袭深度的能力时，排除2种罕见的GB恶性肿瘤(黑色素瘤和淋巴瘤)，HRUS的诊断准确率最高，为62.9%；EUS和CT的诊断准确率分别为55.5%和44.4%。结论：HRUS和EUS对1313例息肉样病变的诊断准确率具有可比性。考虑到患者的舒适度和对镇静的要求，我们认为HRUS有可能成为GB息肉样病变和早期GB癌鉴别诊断和分期的重要诊断手段。
Objective: The authors undertook to investigate the diagnostic performance of high-resolution ultrasound (HRUS), and to compare the differential diagnostic and staging accuracies of endoscopic ultrasonography (EUS), HRUS, and multidetector computed tomography for gallbladder (GB) polypoid lesions and GB cancer.Summary of Background Data: Endoscopic ultrasonography was considered the most sensitive diagnostic modality for GB polypoid lesions. However, recent technical advancements in other image modalities including conventional sonography (US) allow the production of comparable images.Methods: A total of 170 patients, with a more than 1-cm sized polypoid GB lesion, and without evidence of definite local invasion to adjacent organs during primary screening, were consecutively enrolled in this prospective, blind, comparative study. After excluding 26 patients with inappropriate medical histories, 144 patients were finally enrolled. All patients underwent surgical resection. Clinical diagnoses were compared with histopathologic findings by diagnostic modality.Results: Of the 144 patients, there were 115 (79.8%) cases of benign GB polypoid lesions and 29 (20.2%) cases of GB cancers. Diagnostic sensitivities for malignancy were 90% for HRUS, 86% for EUS, and 72% for CT. When evaluating the abilities of these modalities to predict GB cancer depth of invasion, we excluded 2 unusual GB malignancies (melanoma and lymphoma), HRUS was found to have the highest diagnostic accuracy of 62.9%; EUS and CT had accuracies of 55.5% and 44.4%, respectively.Conclusions: The diagnostic accuracies of HRUS and EUS for the differential diagnosis of 1313 polypoid lesions were comparable. In view of patient comfort and no requirement for sedation, we consider that HRUS is likely to become an important diagnostic modality for the differential diagnosis and staging of GB polypoid lesions and early GB cancer.