胃肠胰神经内分泌肿瘤诊断方法合理选择及评价

Selection and evaluation of diagnositic methods in gastroenteropancreatic neuroendocrine neoplasm

胃肠胰神经内分泌肿瘤(GEP-NENs)近年来发病率呈逐渐升高趋势。由于其临床表现复杂多样,缺乏特异性,诊断较为困难。临床上对于出现无法用常见疾病解释的临床症状时,应考虑到本病的可能,并且正确选择相应的生化、影像学检查,及早诊断对改善预后有着重要意义。铬粒素A作为通用的诊断标记物临床上具有较好的应用前景;各种特异性胃肠肽类激素水平升高对于诊断相应的功能性GEP-NENs,如胰岛素瘤、胃泌素瘤等有着较好的特异性;常规影像学检查在定位诊断方面特异性较差,目前生长抑素受体显像和特殊标记的PET检查特异性较好,超声内镜对于诊断胃十二指肠、结肠和胰腺的神经内分泌肿瘤有着特殊优势。总之,随着各种诊断技术的发展和改善,将大大提高GEP-NENs的诊断率。

The incidence of gastroenteropancreatic neuroendocrine neoplasm （GEP-NENs） is increasing in recent years. Due to complicated clinical manifestations and less specificity, the diagnosis is difficult. When the clinical symptoms are hard to explain by common diseases, GEP-NENs should be considerdd. Appropriate biochemical tests as well as imaging examinations should be chosen to help early diagnosis, which is important to improve prognosis. As a general used biomarker for diagnosis, Chromogrnin A has good prospective application. Elevated level of various gastrointestinal peptide hormones has good specificity for diagnosis of corresponding functional GEP-NENs, such as insulinoma, gastrinoma, etc. Regular imaging examination has poor specificity for localization diagnosis in GEP-NENs. Somatostatin receptor scintigraphy （SRSS） and special labeled PET examination have shown high specificity recently. Endoscopic uhrosonography has particular advantage for diagnosis of gastroduodenal, colon and pancreatic neuroendocrine tumor. In conclusion, as development and improvement of various diagnostic techniques, the diagnostic rate of GEP-NENs will be increased significantly.