超声内镜与多层螺旋CT诊断胰腺神经内分泌肿瘤的价值

目的:探讨超声内镜(EUS)与多层螺旋CT(MSCT)诊断胰腺神经内分泌肿瘤(pNENs)的价值.方法:回顾性分析2012年至2016年43例均行EUS和MSCT检查并经组织病理学确诊为pNENs患者的临床、影像和病理资料,比较EUS和MSCT对pNENs的检出率和敏感性,并分析EUS和MSCT在肿瘤最大径≥2 cm或<2 cm、功能性或无功能性pNENs诊断中是否存在差异.结果:43例经组织病理学确诊的pNENs中,男23例、女20例,年龄(57.2±13.6)岁(28~75岁),肿瘤最大径(2.6±2.1) cm(0.6~7.3 cm),其中19例≥2 cm、24例<2 cm,功能性pNENs 26例、非功能性pNENs 17例.总体而言,EUS和MSCT检出率分别为90.7%(39/43)和69.8%(30/43),差异具有统计学意义(P=0.015);EUS和MSCT敏感性分别为71.8%(28/39)和73.3%(22/30),差异无统计学意义(P=0.887).按肿瘤最大径不同比较:EUS和MSCT对肿瘤最大径≥2 cm pNENs的检出率分别为100%(19/19)和100%(19/19),差异无统计学意义(P=1.000);敏感性分别为73.7%(14/19)和78.9%(15/19),差异无统计学意义(P=0.703).EUS和MSCT对肿瘤最大径<2 cm pNENs的检出率分别为83.3%(20/24)和45.8%(11/24),差异具有统计学意义(P=0.007);敏感性分别为70.0%(14/20)和63.6%(7/11),差异无统计学意义(P=0.717).按肿瘤有无功能比较:EUS和MSCT对功能性pNENs的检出率分别为88.5%(23/26)和53.8%(14/26),差异有统计学意义(P=0.006);敏感性分别为73.9%(17/23)和64.3%(9/14),差异无统计学意义(P=0.534).EUS和MSCT对非功能性pNENs的检出率分别为94.1%(16/17)和94.1%(16/17),差异无统计学意义(P=1.000);敏感性分别为68.8%(11/16)和81.3%(13/16),差异无统计学意义(P=0.414).结论:MSCT对直径≥2 cm 的pNENs检出率和敏感性较好,但对直径<2 cm的pNENs检出率和敏感性较低,有必要联合EUS检查.

The value of endoscopic ultrasonography and multi-slice spiral CT in the diagnosis of pancreatic neuroendocrine neoplasms

Objective:To investigate the value of endoscopic ultrasonography(EUS) and multi-slice spiral CT(MSCT) in the diagnosis of pancreatic neuroendocrine neoplasms(pNENs).Methods:The clinical,imaging and pathological data of 43 patients underwent both EUS of MSCT examination and received pathological diagnosis of pNENs from 2012 to 2016 were retrospectively analyzed.The overall detection rate and sensitivity of EUS and MSCT to pNENs were compared.The differences of diagnosis value between EUS and MSCT in tumor size(more than 2 cm or less than 2 cm) and type(functioning or non-functioning) of pNENs were analyzed.Results:In the total of 43 patients with histologically confirmed pNENs,there were 23 male and 20 female.The mean age was (57.2±13.6) years(range:28~75 years).The mean maximum diameter of the tumor was (2.6±2.1) cm(range:0.6~7.3 cm),with a maximum diameter ≥2 cm in 19 patients and <2 cm in the remaining 24 cases.The case series included 26 functional and 17 non-functional pNENs.Overall,the detected rate of EUS and MSCT were 90.7%(39/43) and 69.8%(30/43) respectively(P=0.015),and the sensitivity of EUS and MSCT were 71.8%(28/39) and 73.3%(22/30) respectively(P=0.887).According to the difference in tumor size,the detection rate for pNENs with a diameter ≥2 cm by using EUS and MSCT were 100%(19/19) and 100%(19/19) respectively(P=1.000),and the sensitivity was 73.7%(14/19) and 78.9%(15/19) respectively(P=0.703).The detection rate of EUS and MSCT for pNENs with a diameter <2 cm were 83.3%(20/24) and 45.8%(11/24)(P=0.007),and the sensitivity were 70.0%(14/20) and 63.6%(7/11) respectively(P=0.717).According to the difference in tumor type,the detection rate of EUS and MSCT for functioning pNENs were 88.5%(23/26) and 53.8%(14/26)(P=0.006),and the sensitivity were 73.9%(17/23) and 64.3%(9/14) respectively(P=0.534).The detection rate of EUS and MSCT for non-functioning pNENs were 94.1%(16/17) and 94.1%(16/17)(P=1.000),and the sensitivity were 68.8%(11/16) and 81.3%(13/16) respectively(P=0.414).Conclusion:The detection rate and sensitivity of MSCT for pNENs with a diameter ≥2 cm are better,but worse for diameter less than 2 cm.EUS should be used for the pNENs detection,particularly when the lesion is small.