超声内镜对胰腺癌可切除性评估的价值分析

目的探讨内镜超声检查术(EUS)对胰腺癌的可切除性评估的价值。方法收集在术前均经EUS、BUS以及CT检查,后经手术治疗,并最终为病理组织学证实为胰腺癌的病例。对EUS在术前对胰腺癌的可切除性评估进行回顾分析,以手术结果为金标准进行对比,并与BUS以及CT诊断结果进行比较。结果21例接受手术治疗,其中6例术前EUS认为可切除,实际术中切除5例,EUS评估胰腺癌可切除性的准确度为83.3%;15例术前EUS评估为不可切除,实际手术无法切除14例,EUS评估不可切除准确度为93.3%。提示EUS术前评估结果与手术结果一致性较好。EUS诊断胰腺癌准确率为95.2%,CT为90.5%,B超为71.4%。结论应用EUS评估胰腺癌的可切除性是一种有效的方法。     

不同影像学检查对胰腺癌肿瘤大小及周围组织浸润的前瞻性评估

目的 前瞻性评估超声(US)、螺旋CT(HCT)、内镜超声(EUS)和核磁共振成像(MRI)在胰腺癌肿瘤大小测量及肿瘤周围组织浸润的预测价值及其临床意义.方法 对68例手术治疗的胰腺癌患者术前进行US、HCT、EUS和MRI检查,每种方法均由2位医师对其肿瘤最大径、最小径及肿瘤周围组织浸润情况进行前瞻性评估,并与手术病理结果进行对比.结果在US、HCT、EUS和MRI等4种检查方法中,EUS是评估肿瘤大小最准确的方法,最大径和最小径的回归系数分别为1.0250(P=0.0426)和0.9873(P＜0.0001).在局部组织侵犯的评估中,EUS准确率(75.8%)和敏感性最高(80.0%),而MRI的阳性预测值(97.4%)最高.单元Logistic回归显示,在胰腺癌局部组织侵犯预测方面,任何一种检查方法与手术病理结果均无相关性(P＞0.05).结论 EUS是评估胰腺癌肿瘤大小最准确的方法,在肿瘤局部组织侵犯预测方面尚需多种方法联合应用.     

内镜超声检查在早期胃癌术前分期的应用

目的　探讨内镜超声检查 (EUS)在早期胃癌术前分期中的临床应用价值。方法　对14 9例经胃镜活检证实的胃癌患者 (其中早期胃癌 33例 )术前行内镜超声检查 ,并与术后病理检查结果对照。结果　EUS对胃癌T分期的准确率为 80 .3% ,其中T1期为 81.8% ,T2期为 70 .4 % ,T3期为88.9% ,T4期为 71.4 %。EUS鉴别早期和进展期胃癌的准确率达 95 .1% ,而鉴别胃黏膜和黏膜下癌的准确率仅为 6 3.6 %。EUS对黏膜和黏膜下癌的判断准确率分别为 5 2 .9%和 75 .0 % ,而阳性预测值分别达 90 .0 %和 70 .6 %。EUS对隆起型和平坦型早期胃癌浸润深度的判断准确率均为 10 0 % ,对凹陷型的准确率仅 5 8.6 % ;对分化型和未分化型早期胃癌浸润深度的判断准确率分别为 71.4 %和5 7.9% ,差异无显著性 (P >0 .0 5 )。EUS对早期胃癌浸润深度的判断准确率随着肿瘤直径的增大而降低 ,对早期胃癌淋巴结状况的判断准确率为 90 .9% ,对淋巴结转移的敏感性和特异性分别为 6 6 .7%和 96 .3%。结论　内镜超声检查对早期胃癌术前分期具有较高的临床应用价值。     

不同影像学检查对胰腺癌血管浸润及淋巴结转移的前瞻性评估

目的 评价超声(US)、螺旋CT(HCT)、核磁共振成像(MRI)和内镜超声(EUS)等4种影像学检查,对胰腺癌肿瘤局部血管浸润及淋巴结转移的预测价值.方法 对68例胰腺癌患者术前分别进行US、HCT、MRI和EUS检查,记录其肿瘤局部血管浸润及淋巴结转移的手术病理结果,对影像学检查与手术病理结果的一致性和相关性进行分析.结果 (1)US对于肿瘤侵犯下腔静脉、脾动脉、脾静脉的评估与手术病理结果中度一致,HCT对肿瘤侵犯肠系膜上静脉、门静脉、脾静脉的评估结果与手术病理结果高度一致,对肠系膜上动脉、下腔静脉、脾动脉、肝总动脉、肝固有动脉、腹腔动脉干、腹主动脉的评估结果与手术病理结果中度一致.MRI对肿瘤侵犯肠系膜上动脉、肠系膜上静脉、脾动脉、脾静脉的评估结果与手术病理结果中度一致.EUS对肿瘤侵犯脾静脉的评估结果与手术病理结果高度一致,对肿瘤侵犯肠系膜上静脉的评估结果与手术病理结果中度一致.(2)对淋巴结转移的评估,EUS具有最高的敏感性(75.0%)、准确性(87.5%)和阴性预测值(91.7%).HCT和MRI的敏感性明显低于EUS,分别为37.5%和35.3%,US敏感性最低,仅为18.7%.多因素Logistic回归分析结果显示,EUS对淋巴结转移具有独立预测价值(OR=34.50,95%CI:6.54～182.09).结论 HCT评估胰腺癌肿瘤局部血管浸润与手术发现一致性最好,EUS对胰腺癌淋巴结转移具有独立预测价值.     

Identification and staging of pancreatic tumours using computed tomography,endoscopic ultrasound and mangafodipir trisodium‐enhanced magnetic resonance imaging

Pancreatic malignancy can be staged by a number of different investigations, either alone or in combination. The purpose of the present study was to compare the use of endoscopic ultrasound, CT and mangafodipir trisodium‐enhanced MRI for the staging of pancreatic malignancy, particularly with respect to determining resectability prior to surgery. Twenty‐seven patients referred for the investigation of a suspected pancreatic malignancy were entered into the trial. All patients had contrast‐enhanced CT, gadolinium and mangafodipir trisodium‐enhanced MRI, and endoscopic ultrasound (EUS). Images were assessed for nodal staging, tumour staging and resectability for each investigation, and the results compared with findings at surgery. The results for the accuracy of MRI, CT and EUS, in detecting T4 disease versus T3 or lower was 78, 79 and 68%, respectively; nodal involvement was 56, 63 and 69%, respectively; and overall resectability (including the T stage, presence of involved nodes and metastases) was 83, 76 and 63%, respectively. There was no significant difference demonstrated between the three tests. The present study suggests that for patients referred for investigation and staging of pancreatic malignancy, EUS and MRI scanning convey little advantage over contrast‐enhanced CT. Furthermore, although mangafodipir trisodium improved the conspicuity of pancreatic tumours, it has little influence on T staging.     

超声内镜对胰腺及壶腹癌术前分期及可切除性的评估

目的 观察超声内镜（EUS）诊断胰腺及壶腹部癌分期和血管侵犯的准确性和敏感性,并与术后病理结果进行比较,以确定其可切除及不可切除的预期值。方法 通过EUS扫描对42例胰腺癌和18例壶腹癌患者进行术前分期及血管侵犯的诊断。做好术前内镜检查准备后,持镜插入食管,至十二指肠降部,吸去肠、胃腔内的气体,依次注入脱气水200及500ml,以充盈肠及胃腔,有利超声传导。对胰头及壶腹各部结构进行超声扫描,并退镜至胃窦、胃体及胃底部,对胰头、胰体及胰尾部扫描,找见靶灶即摄片,供分析诊断。本组中的58例同时还进行了CT扫描。结果 （1）EUS的T分期准确率：胰腺癌的1、2、1、3、T4期分别为100．0％（5／5）、75．0％（9／12）和48．0％（12／25）,壶腹部癌的T1、1、2、1、3、T4期分别为75．0％（3／4）、66．7％（2／3）、75．0％（6／8）和33．3％（1／3）;N分期准确率：胰腺癌的N1和N0期分别为80．0％（4／5）和90．0％（9／10）;壶腹部癌的N1和N0期分别为50．0％（3／6）和91．0％（10／11）。（2）EUS及CT扫描对胰腺及壶腹部癌血管侵犯的诊断及其可切除与不可切除预期值的比较：60例EUS诊断的敏感性、特异性、可切除及不可切除预期值分别为52．9％（9／17）、93．1％（27／29）、77．1％（27／35）和8178％（9／11）;58例CT分别为11．8％（2／17）、92．6％（25／27）、62．5％（25／40）和50．0％（2／4）。结论 EUS是目前影像技术中诊断胰腺及壶腹部癌T分期及其血管侵犯最精确、敏感的方法之一;EUS分辨力高（7．5MHz=1．0mm）,可以发现胰腺及壶腹部≤2．0cm的小胰癌;但对胰腺及壶腹部癌的多发微小转移灶,则多不能发现。     

超声内镜在胃癌诊断和分期中的价值

目的：评估超声内镜在胃癌诊断中的应用价值.方法：106例患者于术前行超声内镜、胃镜检查与组织活检病理检查,并将其分期结果与术后病理学检查分期结果比较.结果：胃镜结合病理活检诊断率93.4%（99/106）,超声内镜诊断率为85.0%（90/106）.两者联合运用诊断率为100%.超声内镜对胃癌术前分期结果准确率达到81.1%（86/106）;淋巴结转移准确率为72.2%（70/97）.结论：超声内镜对诊断胃癌有较高的临床价值,并可有效地判断胃癌的分期和淋巴转移状况.     

应用MRI评价胰腺癌胰周血管侵犯预测胰腺癌的可切除性

目的评价MRI判断胰腺癌胰周血管侵犯程度的价值,探讨MRI预测胰腺癌可切除性的最佳界点。方法搜集经手术病理证实的胰腺癌患者41例,均行MRI平扫及增强扫描,37例加做冠状位增强磁共振血管造影(MRA)。术前根据MRI表现,判断胰周血管侵犯情况,按照肿瘤对周围血管侵犯程度的不同,采用1级、2a级、2b级、3a级、3b级和4级进行评价,统计各分级血管的条数,并与手术结果对照。计算以2级和2a级作为可切除判断标准的敏感性、特异性、阳性预测值、阴性预测值和准确率应用受试者工作特性曲线(ROC)确定MRI预测胰腺癌可切除性的最佳界点。结果41例患者中,切除22例,其中20例为根治性切除,2例为姑息性切除。与手术结果对照,MRI共误诊7条血管,其中动脉3条,静脉4条。以1级、2a级、2b级、3a级和3b级作为可切除的标准,判断肿块不可切除的敏感性分别为78.3%、84.8%、67.4%、56.5%和47.8%。ROC曲线显示,以2a级作为MRI预测胰腺癌可切除的最佳界点。结论胰周血管侵犯2a级可作为MRI预测胰腺癌可切除的最佳界点。     

Évaluation de la résécabilité des tumeurs pancréatiques par le scanner conventionnel. Corrélation radiochirurgicale

Pancreatic carcinoma is one of the most serious tumors. One hundred seventy-five patients with pancreatic tumors underwent an abdominal CT scan for the conventional balance of resectability. The results of this examination were compared with the surgical results. Statistical analysis showed 95% sensitivity, 28.8% specificity, and 93% accuracy in determining the resectability of the lesion. The positive predictive value came to 35.08%, while the negative predictive value was 93.8%.     

食管癌术前超声内镜T、N分期与术后病理T、N分期的比较

目的:探讨超声内镜（endoscopic ultrasonography,EUS）在食管癌术前TNM分期中的诊断价值。方法:回顾分析43例食管癌根治术患者术前超声内镜的T、N分期与术后病理学的T、N分期,以术后病理分期为金标准,比较两种分期的一致性。结果:食管癌术前EUS检查T、N分期的诊断准确率分别为82.50%和47.53%,其中T1为83.35%、T2为82.65%、T3为82.32%、T4为84.45%,N0为74.63%、N1为72.75%、N2为55.35%、N3为25.27%。EUS的T分期与病理T分期结果一致性较好（Kappa=0.724,P<0.05）;EUS的N0、N1分期与病理N0、N1分期结果一致性较好,而N2、N3的一致性则相对较差,但总体一致性比较仍具有统计学意义（Kappa=0.408,P<0.05）。结论:EUS判断食管癌T、N分期诊断准确率较高,可作为术前治疗方法选择的重要依据。     

Assessment of resectability of carcinoma of the pancreatic head by ultrasonography and computed tomography. A retrospective analysis

In order to establish the reliability of the assessment of tumour stage and hence of resectability of carcinoma of the pancreatic head by ultrasonography (US) and computed tomography (CT) a retrospective analysis was performed on 41 patients. Both direct imaging techniques were very accurate in detecting non-resectable disease, 100 and 85% respectively, but were much less accurate in predicting resectable cancer, 18 and 15% respectively. False-resectable results were established in 58% of US examinations and 42% of CT examinations. As demonstrated in this study, predicting resectability of carcinoma of the pancreatic head with US and CT is an inadequate method of assessing tumour stage and should be complemented by other techniques to ensure a reliable result.     

超声造影评估乳腺癌周围血管受侵程度及可切除性的价值

目的探讨超声造影评估乳腺癌周围血管受侵程度及可切除性的价值。方法选择诊治的乳腺癌患者98例作为研究对象,所有患者都给予超声造影检查,记录造影特征并判定周围血管受侵程度及可切除性。结果在98例患者中,超声造影达峰时间为(16.44±0.65)s,峰值强度为(0.16±0.05)dB。诊断为周围血管受侵85例,其中动脉血管受侵48例,静脉血管受侵37例,判断周围血管受侵程度的准确率为88.8%,Kappa值为0.789。超声造影判断乳腺癌可切除性的敏感性、特异性、准确性为96.2%、95.0%和95.9%。COX风险回归模型结果显示临床分期、年龄、周围血管受侵、达峰时间、峰值强度都为影响手术切除的主要独立危险因素(P<0.05)。结论超声造影可准确评估乳腺癌周围血管受侵程度及可切除性,有助于病情判断与手术治疗,具有很好的应用价值。     

术前应用螺旋CT超声内镜和PET-CT检查诊断胃癌侵犯胰腺的临床意义

目的 评估在螺旋CT筛选出胃癌侵犯胰腺病例的基础上,联合应用超声内镜(EUS)和PET-CT检查对胃癌侵犯胰腺的术前诊断价值.方法 前瞻性选取60例术前螺旋CT检查诊断为胃癌侵犯胰腺的患者,联合EUS检查(60例)和PET-CT检查(14例),判断是否存在胃癌侵犯胰腺,并与手术探查和术后病理结果 进行对照.结果 手术探查和术后病理结果 显示,60例患者中,38例存在胰腺侵犯,22例无胰腺侵犯.CT在胃癌侵犯胰腺方面诊断的准确率为63.3%,过度诊断率为36.7%.在CT诊断的基础上,结合EUS检查诊断胃癌侵犯胰腺的准确率达到87.8%,过度诊断率为7.3%,与单纯使用螺旋CT检查相比,差异具有统计学意义(P<0.01);与PET-CT检查相比,差异无统计学意义(P>0.05).螺旋CT和EUS检查在诊断胃癌侵犯胰腺位置、侵犯胰腺程度等方面比PET-CT检查更有优势(P<0.01).结论 术前应用螺旋CT诊断胃癌侵犯胰腺的准确率尚有待提高;在螺旋CT检查的基础上联合应用EUS可提高术前诊断的准确率;螺旋CT和EUS检查在诊断胃癌侵犯胰腺位置、侵犯胰腺程度等方面可提供比PET-CT更多的信息.     

多层螺旋CT三期增强扫描在胰腺癌术前评估中的价值

目的分析多层螺旋CT三期增强扫描在胰腺癌术前评估中的价值。方法将临床因怀疑胰腺癌而申请MDCT检查的病例行三期增强扫描,扫描时相及延迟时间分别为：动脉期20s、胰腺实质期45s、门脉期70s,并进行图像后处理;图像分析内容包括肿瘤位置、有无周围器官及主要血管的侵犯、有无器官转移、腹膜或腹腔转移等,最后评估肿瘤是否可以手术切除,并与手术结果对照。结果多层螺旋CT三期增强扫描对于胰腺癌术前可切除性评价的阳性预测值、阴性预测值、敏感性、特异性及准确性分别为100％、87．5％、97．1％、100％及97．6％。结论胰腺实质期与门脉期应作为胰腺癌术前MDCT增强的最基本扫描时相,如果需要进一步观察胰周动脉走行及肿瘤的供血情况,可以加做动脉期扫描;以原始横断位图像为基础,结合MPR、MIP、VR、CPR等重建技术,MDCT对于胰腺癌的术前可切除性评价多能做出正确诊断。     

Role of endoscopic ultrasound in the diagnosis of pancreatic cancer

Endoscopic ultrasonography (EUS) with or without fine needle aspiration has become the main technique for evaluating pancreatobiliary disorders and has proved to have a higher diagnostic yield than positron emission tomography, computed tomography (CT) and transabdominal ultrasound for recognising early pancreatic tumors. As a diagnostic modality for pancreatic cancer, EUS has proved rates higher than 90%, especially for lesions less than 2-3 cm in size in which it reaches a sensitivity rate of 99% vs 55% for CT. Besides, EUS has a very high negative predictive value and thus EUS can reliably exclude pancreatic cancer. The complication rate of EUS is as low as 1.1%-3.0%. New technical developments such as elastography and the use of contrast agents have recently been applied to EUS, improving its diagnostic capability. EUS has been found to be superior to the recent multidetector CT for T staging with less risk of overstaying in comparison to both CT and magnetic resonance imaging, so that patients are not being ruled out of a potentially beneficial resection. The accuracy for N staging with EUS is 64%-82%. In unresectable cancers, EUS also plays a therapeutic role by means of treating oncological pain through celiac plexus block, biliary drainage in obstructive jaundice in patients where endoscopic retrograde cholangiopancreatography is not affordable and aiding radiotherapy and chemotherapy.     

超声内镜在食管癌TN分期中的应用

目的评价超声内镜（EUS）对食管癌术前TN分期的准确性。方法40例食管癌患者术前行超声内镜检查,与术后病理结果相对照。结果EUS对食管癌侵犯深度判断总的准确性为85%。对是否有区域淋巴结转移判断的准确性为77.5%,敏感度为78.6%,特异性为76.9%,阳性预测值为64.7%,阴性预测值86.9%。结论EUS能较准确的判断食管癌TN分期,可作为术前治疗方法选择的重要依据。     

Prognostic value and interobserver agreement of endoscopic ultrasonography for superficial squamous cell carcinoma of the esophagus

Background and Aims. Submucosal invasion of superficial esophageal cancer (SEC) is related to the prognosis. We prospectively analyzed outcomes of SEC in patients staged by endoscopic ultrasonography (EUS). Patients and Methods. We staged 31 endoscopically diagnosed SEC cases using a 20/15-MHz thin probe. The EUS tumor stage was classified as EUSM (limited within mucosa), EUS-SM (with submucosal invasion), or EUS-MP over (invading the muscularis propria or deeper). Lymph node metastasis and 2-yr survival were analyzed according to the EUS tumor stage in 29 squamous cell carcinoma cases. Interobserver agreement of the EUS stage was tested between the examiner and a blind reviewer. Results. Lymph node metastasis was significantly frequent in the EUS-SM group (8 of 18 cases [44.4%]) compared with the EUS-M group (1 of 10 cases [10%]) (p=0.03). Patient survival at 2 yr after initial therapy was 72.2% in the EUS-SM group and 90% in the EUS-M group. Death from cancer was noted only in the EUS-SM group (three cases). The accuracy rates of EUS tumor staging were 74.1% by the examiner and 66.7% by the blind reviewer, with moderate interobserver agreement (κ=0.46). Conclusions. Thin-probe EUS can classify SEC into two groups: the EUS-M group with excellent outcome and the EUS-SM group with a significant risk of lymph node metastasis.     

Computed tomography, endoscopic, laparoscopic, and intra-operative sonography for assessing resectability of pancreatic cancer

Pancreas cancer is the fourth leading cancer killer in adults. Cure of pancreas cancer is dependent on the complete surgical removal of localized tumor. A complete surgical resection is dependent on accurate preoperative and intra-operative imaging of tumor and its relationship to vital structures. Imaging of pancreatic tumors preoperatively and intra-operatively is achieved by pancreatic protocol computed tomography (CT), endoscopic ultrasound (EUS), laparoscopic ultrasound (LUS), and intra-operative ultrasound (IOUS). Multi-detector CT with three-dimensional (3-D) reconstruction of images is the most useful preoperative modality to assess resectability. It has a sensitivity and specificity of 90 and 99%, respectively. It is not observer dependent. The images predict operative findings. EUS and LUS have sensitivities of 77 and 78%, respectively. They both have a very high specificity. Further, EUS has the ability to biopsy tumor and obtain a definitive tissue diagnosis. IOUS is a very sensitive (93%) method to assess tumor resectability during surgery. It adds little time and no morbidity to the operation. It greatly facilitates the intra-operative decision-making. In reality, each of these methods adds some information to help in determining the extent of tumor and the surgeon's ability to remove it. We rely on pancreatic protocol CT with 3-D reconstruction and either EUS or IOUS depending on the tumor location and operability of the tumor and patient. With these modern imaging modalities, it is now possible to avoid major operations that only determine an inoperable tumor. With proper preoperative selection, surgery is able to remove tumor in the majority of patients.     

18F-FDG PET/CT与增强CT对胰腺癌可切除性评估价值分析

目的:探讨18F-FDG PET/CT与增强CT对胰腺癌可切除性评估价值。方法:回顾性分析病理、术中所见或临床综合及随访资料证实的胰腺癌病人18F-FDG PET/CT和增强CT影像资料,对比二者及二者联合对胰腺癌可切除性评估价值。结果:74例病人中24例进行了手术,其中仅15例成功完整切除了肿瘤,另9例因术中发现不可切除因素而行姑息手术。余50例均经随访证实因多发转移而不可切除。以不可切除为阳性指标,18F-FDG PET/CT显像对不可切除评估的灵敏度、特异性及准确性分别为79.66%,86.67%和81.08%,增强CT的灵敏度、特异性及准确性分别为84.75%,93.33%和86.49%,二者差异无显著性。以其中一种方法阳性即认为不可切除,二者联合判断的灵敏度、特异性及准确性分别为91.53%,86.67%和90.54%,显著优于单独PET/CT或增强CT。结论:18F-FDG PET/CT与增强CT均为胰腺癌可切除性评估重要手段,二者价值相似,具有互补性,联合应用准确性更高。     

Diagnosis of Small Pancreatic Carcinoma

A retrospective analysis was performed to evaluate the clinicalsymptoms and abnormal test findings in small pancreatic carcinoma.Five hundred and thirty-six cases of pancreatic carcinoma withthe histology of duct cell carcinoma were collected from 14medical centers in Japan. In 440 of the cases, tumor size wasmeasured at the time of laparotomy or from the resected specimen.Three hundred and seventy-seven patients (86%) had a carcinomalarger than 3.0 cm; only 30% of these were resectable. Sixty-threepatients (14%) had a carcinoma of 3.0 cm or less, with resectabilityof 97%. Detecting a tumor of "3 cm or less" with a high probabilityof resectability is the objective of early diagnosis with theresulting possibility of a cure. In most cases these small carcinomaswere found easily when obstructive jaundice was present (73%).However, the estimated occurrence of obstructive jaundice associatedwith carcinomas of 3 cm or less was only 10% among the totalcases of pancreatic carcinoma studied. Therefore, it is necessaryfor early diagnosis to detect carcinomas of 3 cm or less presentingwithout jaundice. The symptoms of small carcinoma without jaundiceare weight loss, anorexia, upper abdominal pain, back pain anda palpable abdominal mass. Among the various available examinations,endoscopic retrograde cholangiopancreatography, computerizedtomography and ultrasonography were valuable in diagnosing thesesmall carcinomas.