造影增强超声内镜联合超声内镜引导下细针抽吸术对胰腺占位的诊断价值

目的 探讨造影增强超声内镜(CE-EUS)联合超声内镜引导下细针抽吸术(EUS-FNA)对胰腺占位的诊断价值。 方法 回顾性分析2017年1月~2020年12月175例胰腺占位患者的临床资料,以手术、穿刺病理或随访结果为金标准,符合入组要求的患者有132例,其中行增强CT和/或增强MRI检查组有55例,行EUS检查组有40例,行CE-EUS联合EUS-FNA组有37例,比较三种检查方式在诊断胰腺占位中的价值。 结果 55例胰腺占位行增强CT和/或增强MRI检查结果显示良性13例,恶性42例,敏感度79.49%(31/39)、特异度56.25%(9/16)、阳性预测值81.58%(31/38)、阴性预测值52.94%(9/17)、准确率72.73%(40/55);40例胰腺占位行EUS检查显示结果良性13例,恶性27例,敏感度80.00%(24/30)、特异度60.00%(6/10)、阳性预测值85.71%(24/28)、阴性预测值50.00%(6/12)、准确率75.00%(30/40);37例胰腺占位行CE-EUS联合EUS-FNA检查结果显示良性14例,恶性23例,敏感度93.94%(31/33)、特异度75.00%(3/4)、阳性预测值96.87%(31/32)、阴性预测值60.00%(3/5)、准确率91.89%(34/37)。胰腺癌在CE-EUS下主要表现为不均匀的点状或棒状的低增强模式,在CE-EUS引导下选择在低增强区域行FNA,可提高穿刺的阳性率。 结论 CE-EUS联合EUS-FNA可提高胰腺占位诊断的准确率,值得临床推广。

Diagnostic value of contrast-enhanced endoscopic ultrasonography combined with endoscopic ultrasound-guided fine needle aspiration for pancreatic masses

Objective To explore the diagnostic value of contrast-enhanced endoscopic ultrasonography(CE-EUS)combined with endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)for pancreatic cancer. Methods The clinical data of 175 patients with pancreatic space-occupying lesions treated during Jan. 2017 and Dec. 2020 were retrospectively analyzed. Based on the results of surgery and puncture pathology or follow-up data, 132 patients met the inclusion requirements, including 55 patients who received enhanced CT and/or enhanced MRI, 40 patients who received EUS examination, and 37 patients who received CE-EUS combined with EUS-FNA. The value of the three methods in the diagnosis of pancreatic masses were compared. Results The results of enhanced CT and/or enhanced MRI showed 13 benign cases and 42 malignant cases. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 79.49%(31/39), 56.25%(9/16), 81.58%(31/38), 52.94%(9/17), and 72.73%(40/55), respectively. EUS showed 13 benign cases and 27 malignant cases. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 80.00%(24/30), 60.00%(6/10), 85.71%(24/28), 50.00%(6/12), and 75.00%(30/40), respectively. CE-EUS combined with EUS-FNA showed 14 benign cases and 23 malignant cases. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 93.94%(31/33), 75.00%(3/4), 96.87%(31/32), 60.00%(3/5), and 91.89%(34/37), respectively. Pancreatic masses showed uneven spots or rod-like low enhancement mode under CE-EUS, and FNA in the low enhancement area could improve the positive rate of puncture. Conclusion CE-EUS combined with EUS-FNA can improve the diagnostic accuracy of pancreatic masses, which is worthy of clinical promotion.