超声内镜弹性成像和应变率在胰腺实性肿块良恶性鉴别诊断中的价值初探
|
摘要
目的:初步探讨超声内镜弹性成像评分和应变率比值在胰腺实性肿块的良恶性鉴别诊断中的价值。方法:将具有胰腺实性肿块的38例患者纳入研究,通过超声内镜弹性成像检查,获得弹性成像评分和应变率比值,对照诊断标准,计算弹性成像评分和应变率比值对于胰腺实性肿块良恶性的诊断准确性、灵敏度和特异度等,并且使用受试者工作特征曲线来确定应变率比值的截断值。结果:在38例胰腺实性肿块的患者中,手术或超声内镜引导下穿刺病理等显示良性肿块有12例(炎性肿块10例、无功能性内分泌瘤2例),恶性的肿块26例(胰腺癌)。超声内镜弹性成像评分诊断胰腺恶性实性肿块的准确性、灵敏度和特异度分别为89.5%、92.3%、83.3%。良性组的弹性应变率比值平均为(11.64±13.47),恶性组的平均为(34.04±18.33),两组弹性应变率比值有显著统计学差异(P<0.05),我们通过受试者工作特征曲线最终确定弹性应变率比值的临界值为22.46,以22.46为截断值,诊断的敏感性为79.6%,特异性91.%。弹性成像评分联合应变率比值共同诊断时准确性、灵敏度、特异度和阳性预测值以及阴性预测值分别高达94.7%、96.2%、91.7%、96.2%、91.7%。结论:超声内镜弹性成像评分在胰腺实性肿块的良恶性鉴别中具有较高的准确性,联合弹性应变率比值可提高其诊断价值,为超声内镜检查及胰腺实性肿块提供了一项新的诊断方法。
Objective: To evaluate the accuracy of the endoscopic ultrasonography(EUS) elastography score and strain ratio(SR) in the differential diagnosis of benign and malignant solid pancreatic lesions. Methods: A total of 38 patients with solid pancreatic lesions identified by endoscopic ultrasound were enrolled in the study to evaluate the efficacy of elastography and SR in differentiating malignant from benign lesions. The semiquantitative score of elastography was represented by the SR method. Sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV), and accuracy were calculated by comparing the diagnoses made by elastography, SR and final diagnoses. According to Young 's modulus, a receiver operating characteristic(ROC) curve was drawn, and it used to identify the value of strain ratio for differential diagnosis of solid pancre-atic lesions. Result: Elastography was successfully performed in all patients and there were no procedure related complications.Twenty-six patients were finally diagnosed with pancreatic carcinoma, 2 with benign endocrine tumor and 10 with focal pan-creatitis. According to our diagnostic criteria of elastography, the overall accuracy of EUS elastography for the differential di-agnosis of focal pancreatic masses was 89.5%(34/38), with a sensitivity, specificity of 92.3%, 83.3%, respectively. Malignant lesions had significantly higher median SR(34.04±18.33) than benign lesions(11.64±13.47). The best cut-off level of SR to obtain the maximal area under the curve was 22.46 with a sensitivity of 79.6%, specificity of 91% through ROC curve. Com-bined elastography to SR resulted in an accuracy of 94.7%, sensitivity of 96.2%, specificity of 91.7%, PPV of 96.2%, and NPV of 91.7% for the diagnosis of solid pancreatic lesions. Conclusion: EUS elastography has a relatively high accuracy for the differentiation of benign and malignant pancreatic lesions, combined with SR would increase the accuracy.
Objective: To evaluate the accuracy of the endoscopic ultrasonography(EUS) elastography score and strain ratio(SR) in the differential diagnosis of benign and malignant solid pancreatic lesions. Methods: A total of 38 patients with solid pancreatic lesions identified by endoscopic ultrasound were enrolled in the study to evaluate the efficacy of elastography and SR in differentiating malignant from benign lesions. The semiquantitative score of elastography was represented by the SR method. Sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV), and accuracy were calculated by comparing the diagnoses made by elastography, SR and final diagnoses. According to Young 's modulus, a receiver operating characteristic(ROC) curve was drawn, and it used to identify the value of strain ratio for differential diagnosis of solid pancre-atic lesions. Result: Elastography was successfully performed in all patients and there were no procedure related complications.Twenty-six patients were finally diagnosed with pancreatic carcinoma, 2 with benign endocrine tumor and 10 with focal pan-creatitis. According to our diagnostic criteria of elastography, the overall accuracy of EUS elastography for the differential di-agnosis of focal pancreatic masses was 89.5%(34/38), with a sensitivity, specificity of 92.3%, 83.3%, respectively. Malignant lesions had significantly higher median SR(34.04±18.33) than benign lesions(11.64±13.47). The best cut-off level of SR to obtain the maximal area under the curve was 22.46 with a sensitivity of 79.6%, specificity of 91% through ROC curve. Com-bined elastography to SR resulted in an accuracy of 94.7%, sensitivity of 96.2%, specificity of 91.7%, PPV of 96.2%, and NPV of 91.7% for the diagnosis of solid pancreatic lesions. Conclusion: EUS elastography has a relatively high accuracy for the differentiation of benign and malignant pancreatic lesions, combined with SR would increase the accuracy.
引文
[1]仲艳密,宁春平,房世保,等.超声弹性应变率比值对鉴别甲状腺良恶性结节影响因素的研究[J].中华超声影像学杂志,2015,24(3):228-231.
[2]Nemakayala D, Patel P, Rahimi E, et al. Use of quantitative endoscopic ultrasound elastography for diagnosis of pancreatic neuroendocrine tumors[J]. Endosc Ultrasound, 2016, 5(5):342-345.
[3]Giovannini M, Bories E, Monges G, et al. Sonoelastography guided by endoscopic ultrasound:the first step towards virtual biopsy? Preliminary results in 49 patients[J]. Endoscopy, 2006, 63(5):344-348.
[4]郭瑾陶,孙思予,葛楠,等.内镜超声定量弹性成像技术对胰腺良恶性病变鉴别诊断价值研究[J].中国实用内科杂志,2013,33(10):808-811.
[5]贾芳,徐有青,郭玉宁.超声内镜弹性成像鉴别诊断胰腺占位价值研究[J].人民军医,2014,57(8):871-872.
[6]徐萍,任大宾,金霞东.超声内镜实时组织弹性成像的应用[J].中国内镜杂志,2010,16(2):162-165.
[7]Giovannini M, Thomas B, Erwan B, et al. Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses:A multicenter study[J]. World J Gastroenterol, 2009, 15(13):1587-1593.
[8]Yamabe A, Irisawa A, Bhutani MS, et al. Efforts to improve the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for pancreatic tumors[J]. Endosc Ultrasound, 2016, 5(4):225-232.
[9]彭斌,黄强,林先盛,等.超声内镜弹性成像鉴别诊断胰腺实性肿块良恶性价值的Meta分析[J].世界华人消化杂志,2015,23(31):5070-5078.
[10]Mehmood S, Jahan A, Loya A, et al. Onsite cytopathology evaluation and ancillary studies beneficial in EUS-FNA of pancreatic, mediastinal, intra-abdominal, and submucosal lesions[J].Diagn Cytopathol, 2015, 43(4):278-286.
[11]Hewitt MJ, Mcphail MJ, Possamai L, et al. EUS-guided FNA for diagnosis of solid pancreatic neoplasms:a meta-analysis[J].Gastrointest Endosc, 2012, 75(2):319-331.
[12]Sftoiu A, Vilmann P. Differential diagnosis of focal pancreatic masses by semiquantitative EUS elastography:between strain ratios and strain histograms[J]. Gastrointest Endosc, 2013, 78(1):188-189.
[13]徐凯,徐萍,任大宾,等.超声内镜弹性成像在良恶性胰腺病变鉴别中的应用价值[J].世界华人消化杂志,2012,20(5):425-429.
[14]Soares J, Iglesiasgarcia J, Gonalves B, et al. Interobserver agreement of EUS elastography in the evaluation of solid pancreatic lesions[J]. Eur J Heart Failure, 2015, 4(3):244-249.
[15]Dietrich CF, Jenssen C, Arcidiacono PG, et al. Endoscopic ultrasound:Elastographic lymph node evaluation[J]. Endosc Ultrasound, 2015, 4(3):176-190.
[16]Kim SY, Cho JH, Kim YJ, et al. Diagnostic efficacy of quantitative endoscopic ultrasound elastography for differentiating pancreatic disease[J]. J Gastroenterol Hepatol, 2017, 32(5):1115.
[17]Dawwas MF, Taha H, Leeds JS, et al. Diagnostic accuracy of quantitative EUS elastography for discriminating malignant from benign solid pancreatic masses:a prospective, single-center study[J]. Gastrointest Endosc, 2012, 76(5):953-961.
[2]Nemakayala D, Patel P, Rahimi E, et al. Use of quantitative endoscopic ultrasound elastography for diagnosis of pancreatic neuroendocrine tumors[J]. Endosc Ultrasound, 2016, 5(5):342-345.
[3]Giovannini M, Bories E, Monges G, et al. Sonoelastography guided by endoscopic ultrasound:the first step towards virtual biopsy? Preliminary results in 49 patients[J]. Endoscopy, 2006, 63(5):344-348.
[4]郭瑾陶,孙思予,葛楠,等.内镜超声定量弹性成像技术对胰腺良恶性病变鉴别诊断价值研究[J].中国实用内科杂志,2013,33(10):808-811.
[5]贾芳,徐有青,郭玉宁.超声内镜弹性成像鉴别诊断胰腺占位价值研究[J].人民军医,2014,57(8):871-872.
[6]徐萍,任大宾,金霞东.超声内镜实时组织弹性成像的应用[J].中国内镜杂志,2010,16(2):162-165.
[7]Giovannini M, Thomas B, Erwan B, et al. Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses:A multicenter study[J]. World J Gastroenterol, 2009, 15(13):1587-1593.
[8]Yamabe A, Irisawa A, Bhutani MS, et al. Efforts to improve the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for pancreatic tumors[J]. Endosc Ultrasound, 2016, 5(4):225-232.
[9]彭斌,黄强,林先盛,等.超声内镜弹性成像鉴别诊断胰腺实性肿块良恶性价值的Meta分析[J].世界华人消化杂志,2015,23(31):5070-5078.
[10]Mehmood S, Jahan A, Loya A, et al. Onsite cytopathology evaluation and ancillary studies beneficial in EUS-FNA of pancreatic, mediastinal, intra-abdominal, and submucosal lesions[J].Diagn Cytopathol, 2015, 43(4):278-286.
[11]Hewitt MJ, Mcphail MJ, Possamai L, et al. EUS-guided FNA for diagnosis of solid pancreatic neoplasms:a meta-analysis[J].Gastrointest Endosc, 2012, 75(2):319-331.
[12]Sftoiu A, Vilmann P. Differential diagnosis of focal pancreatic masses by semiquantitative EUS elastography:between strain ratios and strain histograms[J]. Gastrointest Endosc, 2013, 78(1):188-189.
[13]徐凯,徐萍,任大宾,等.超声内镜弹性成像在良恶性胰腺病变鉴别中的应用价值[J].世界华人消化杂志,2012,20(5):425-429.
[14]Soares J, Iglesiasgarcia J, Gonalves B, et al. Interobserver agreement of EUS elastography in the evaluation of solid pancreatic lesions[J]. Eur J Heart Failure, 2015, 4(3):244-249.
[15]Dietrich CF, Jenssen C, Arcidiacono PG, et al. Endoscopic ultrasound:Elastographic lymph node evaluation[J]. Endosc Ultrasound, 2015, 4(3):176-190.
[16]Kim SY, Cho JH, Kim YJ, et al. Diagnostic efficacy of quantitative endoscopic ultrasound elastography for differentiating pancreatic disease[J]. J Gastroenterol Hepatol, 2017, 32(5):1115.
[17]Dawwas MF, Taha H, Leeds JS, et al. Diagnostic accuracy of quantitative EUS elastography for discriminating malignant from benign solid pancreatic masses:a prospective, single-center study[J]. Gastrointest Endosc, 2012, 76(5):953-961.