Differentiation of small pancreatic mass lesions by the combination of endosonography and genetic analysis of purepancreatic juice

背景与目的：胰腺癌的早期诊断仍很困难。这项前瞻性研究的目的是评估腔内超声检查和纯胰液基因分析相结合在早期识别胰腺癌中的作用。方法：对176例拟诊为胰腺损伤的患者进行超声内窥镜检查。胰腺实性肿块患者经内窥镜采集纯胰液。用聚合酶链式反应-限制性片段长度多态性方法检测果汁中K-ras基因第12位密码子的突变。结果：36例(20%)发现胰腺实性肿块。其中胰腺癌19例(7例，<2 cm)，炎性肿块17例(13例，<2 cm)。虽然内窥镜逆行胰胆管造影术对癌症的诊断准确率很高，但超声和计算机断层扫描的敏感性较低，尤其是在胰腺小肿块，其中65%直到腔内超声检查才被披露。相反，腔内超声表现出高敏感性(100%)和特异性(92%)，即使在小肿块。结合K-ras分析，使用小样本进行安全检测，腔内超声诊断变得更加明确。结论：腔内超声和K-ras分析都是安全的。腔内超声联合K-ras分析对胰腺癌的早期诊断有一定价值。

Background & Aims : The early diagnosis of pancreatic cancer is still difficult. The purpose of this prospective study was to assess the utility of a combination of endosonography and genetic analysis of pure pancreatic juice for the early recognition of pancreatic cancer. Methods : One hundred and seventy-six patients with syspected pancreatic injury were enrolled and underwent endosonography. Pure pancreatic juice was collected endoscopically in patients with solid pancreatic masses. K-ras point mutations at codon 12 in the juice were assayd by polymerase chain reaction-restriction fragment length polymorphism. Results : Thirty-six patients (20%) were found to have solid pancreatic masses. They consisted of 19 patients with pancreatic cancer (7 patients, <less than or equal> 2cm) and 17 patients with an inflammatory pancreatic mass (13 patients, <less than or equal> 2cm). Although endoscopic retrograde cholangiopancreatography showed high accuracy for cancer diagnosis, ultrasonography and computed tomography were less sensitive, particularly in small pancreatic masses, and 65% of them were not disclosed until endosonography. In contrast, endosonography showed high sensitivity (100%) and specificity (92%) even in small masses. Together with K-ras analysis, assayd safely using small samples, the endosonographic diagnosis became more definitive. Conclusions : Both endosonography and K-ras analysis was safely performed. The combination of endosonography and K-ras analysis of pure pancreatic juice may be useful for the early diagnosis of pancre