胰腺癌CT表现与手术病理及D2-40表达的相关性研究

目的:探讨胰腺癌CT征象与手术病理及癌组织淋巴管生成之间的关系.方法:对33例胰腺癌患者(男24例,女9例,年龄38～79岁)行CT平扫及动脉期、门静脉期、延迟期增强扫描,分析胰腺癌的病灶大小、密度、强化程度、对胰周组织的侵犯、胰胆管扩张,胰周淋巴结等CT征象,所有病例均行手术切除,术后标本采用单克隆抗体D2-40免疫组化方法检测肿瘤组织中的瘤周和瘤内淋巴管密度(pLVD,iLVD).使用Kappa检验和t检验统计学方法将CT表现与病理结果、淋巴管密度进行对照.结果:CT诊断胰腺癌病灶的大小、胰周组织侵犯、胰周淋巴结转移与手术病理结果一致性良好(P＜0.05),CT对胰腺癌分期的准确性为78.79％(26/33).CT征象中胰周组织侵犯、胰周淋巴结肿大、分期与胰腺癌pLVD有关(P＜0.05).与iLVD无关(P＞0.05)；CT征象中病灶大小、密度、胰胆管扩张、病灶强化程度则与pLVD、iLVD均无关(P＞0.05).结论:CT能较可靠地反映胰腺癌的病理学特征；胰周组织侵犯、胰周淋巴结肿大等CT征象与胰腺癌组织的淋巴管密度有关,可一定程度上揭示胰腺癌组织的淋巴管生成、淋巴结转移及判断预后.

A comparative study of CT, pathology and the expression of D2-40 in pancreatic carcinoma

Objective：To investigate the correlation among CT features,pathology,and the expression of D2-40 in pancreatic carcinoma（PC）.Methods：A toal of 33 patients（24 males,9 females,aged 38～79 years） with PC were evaluated with CT scanning before operation.Monoclonal antibody D2-40 was used immunohistochemically to detect the lymphatic vessel density（LVD） in the intra and peri-tumoral areas of histological specimen.CT findings were compared with postoperative pathology and the LVD of PC.Results：CT findings such as size,peripancreatic invasion and peripancreatic lymph node metastasis were correlated with postoperative pathology.The staging accuracy of CT was 78.79%（26/33）.CT features including peripancreatic invasion,peripancreatic lymphadenectasis and staging were associated with the pLVD of PC,but not with the iLVD.Neither the pLVD nor the iLVD was correlated with other CT findings such as size,density,pancreatic biliary duct dilation and enhancement.Conclusion：CT can reliably reveal the pathological characteristics of PC,where some CT findings such as peripancreatic invasion,peripancreatic lymphadenectasis could be used for prediction of lymphangiogenesis,lymph node metastasis,and prognosis to a certain extent.