超声内镜弹性成像在良恶性胰腺病变鉴别中的应用价值

目的:探讨超声内镜弹性成像(endoscopic ultrasound,EUS)在胰腺占位病变良恶性鉴别中的应用价值.方法:影像学结果并经超声内镜检查确定有胰腺占位性病变的患者入选,对目标病变行超声内镜弹性成像检查,按照弹性成像5分法对组织弹性成像进行评分,将弹性成像评分为12分归为良性,3-5分归为恶性病变.结果:自2009-06/2011-06,共27例符合标准的胰腺占位病变患者入选,其中胰腺癌19例,超声内镜弹性成像评分3分(n=11)、4分(n=5)、5分(n=3),无功能性良性内分泌肿瘤(4分)及低度恶性神经内分泌肿瘤(5分)各1例,炎性病变6例,评分1分(n=1)、2分(n=3)、3分(n=2).超声内镜弹性成像对27例胰腺占位病变良恶性鉴别中24例诊断准确,诊断灵敏度100%,特异度57.14%,阳性预测值86.96%,阴性预测值100%.结论:超声内镜弹性成像对胰腺良恶性病变的鉴别具有较高的准确性,可望为疾病诊断提供新的影像学手段,但其仍为一种影像学手段,具有一定的局限性,并不替代胰腺的细胞病理学检查.

EUS elastography for the differential diagnosis of pancreatic masses

AIM: To investigate the usefulness of endoscopic ultrasound(EUS) elastography for the differential diagnosis of malignant and benign pancreatic masses. METHODS: Patients with pancreatic masses were enrolled in this study.All patients were examined by EUS and EUS elastography.Elastographic pattern was scored with whole numbers from 1 to 5 based on the color of elastographic images.Scores 1 and 2 were classified as benign and scores 3 to 5 as malignant. RESULTS: Elastography was successfully performed in all patients and there were no procedure-related complications.Nineteen patients were finally diagnosed with pancreatic carcinoma,1 with malignant pancreatic neuroendocrine tumor,1 with benign endocrine tumor and 6 with focal pancreatitis.According to our diagnostic criteria of elastography,the overall accuracy of EUS elastography for the differential diagnosis of focal pancreatic masses was 88.89%(24/27),with a sensitivity,specificity,positive predictive value and negative predictive value of 100%,57.14%,86.96% and 100%,respectively. CONCLUSION: EUS elastography has a relatively high accuracy for the differentiation of benign and malignant pancreatic lesions and may provide an alternative method when EUS-FNA reveals negative results or cannot be performed because of technical problems.