不同影像学方法对胰腺癌T、N、M分期及可切除性的评估

Prospective evaluation of ultrasonography, multi-slice spiral CT, endoscopic ultrasonography, and magnetic resonance imaging in assessment of TNM staging and assessment of resectibility in pancreatic carcinoma

目的前瞻性评估超声（US）、多层螺旋CT（MSCT）、内镜超声（EUS）和核磁共振（MRI）在胰腺癌T、N、M分期及可切除性的预测价值。方法对68例胰腺癌分别进行超声（US）、螺旋CT（MSCT）、核磁共振（MRI）、超声内镜（EUS）检查，评估其在T、N、M分期和可切除性与手术病理结果比较及临床意义。结果EUS对肿瘤大小的独立预测效果最好，最大径回归系数和最小径回归系数分别为1．025（P=0．043）和0．987（P〈0．0001）；在对淋巴结转移的评估中，EUS具有最高的敏感性（75．O％）、准确性（87．5％）和阴性预测价值（91．7％），单元Logistic回归显示与外科发现有显著相关性（DR值：33．00，95％CI：7．18～151．77P〈0．0001），且多元Logistic回归分析证实EUS具独立预测价值（OR值：34．50，95％CI：6．54—182．09，P〈0．0001）。MSCT评估远处转移具最高敏感性88．9％，其对胰腺癌术前TNM分期准确率最高，为61．8％。4种方法对胰腺癌可切除性的判断均与手术结果具有相关性，但多元回归分析尚无一种影像学检查具有独立预测价值。结论MSCT对胰腺癌的TNM分期准确性最高，EUS评估肿瘤大小和淋巴结转移效果最好，对胰腺癌的术前评估尚需要两种以上的方法联合府用。

Objective To evaluate prospectively the efficacy and clinical significance of ultrasonography（ US）, multi-slice spiral CT （MSCT）, magnetic resonance imaging （MRI）, and endoscopic ultrasonography （EUS） in assessment of the TNM staging and reseetibility of pancreatic carcinoma. Methods Consecutive 68 patients with pancreatic carcinoma underwent US, MSCT, MRI, and EUS to assess their efficacies in assessment of the size of carcinoma, lymph node metastasis, and distant metastasis. The results of theses imaging techniques were compared with the surgical and pathological findings. Results EUS was the most precise technique in evaluating the T staging of pancreatic carcinoma with the coefficients of regression of maximum and minimum radiuses of 1. 025 （ P = 0. 043 ） and 0. 987 （ P 〈 0. 0001 ）. In the assessment of lymph node metastasis ,EUS had the highest sensitivity （75.0%） , accuracy （87.5%）, and negative predictive values （91. 7% ）. Univariate logistic regression showed that EUS was significantly correlated with the surgical findings（ OR：33.00, 95% CI： 7.18 - 151.77 P 〈0. 0001 ）. Multivariate logistic regression analysis confirmed that EUS had an independent predictive value （ OR： 34. 50,95% CI： 6.54 - 182.09, P 〈0. 0001 ）. MSCT had the highest sensibility （88.9%）in the assessment of distant metastasis and had the highest accuracy （ 61.8% ） in preoperative TNM staging of pancreatic carcinoma. All 4 imaging techniques were correlated with surgical findings in assessment of the resectibility. Multivariate logistic regression analysis confirmed that none of the imaging techniques had independent predictive value. Conclusion MSCT is the best method in preoperative TNM staging of pancreatic carcinoma. EUS is the best methods in the assessment of tumor size and lymph node metastasis. Preoperative asessment of pancreatic carcinoma needs combination of at least two kinds of imaging techniques.