内镜超声对胰腺导管内乳头状黏液瘤病理类型的诊断价值

Diagnostic value of endoscopic ultrasonography for pathological classifications of intraductal papillary mucinous neoplasm

目的探讨内镜超声对胰腺导管内乳头状黏液瘤(intraductal papillary mucinous neoplasms,IPMN)术前病理分类的价值。方法回顾性分析北京协和医院2008-2018年间62例术前接受内镜超声检查评估IPMN病理类型且术后病理明确为胰腺IPMN的患者资料。探究区分低度异型增生(low grade dysplasia,LGD)、高度异型增生(high grade dysplasia,HGD)和侵袭性癌(invasive cancer,IC)的内镜超声征象,并利用逻辑回归模型制定基于内镜超声特征的评分系统用于IPMN病理类型的术前评估。结果在62例患者中,15例(24.2%)病理为LGD,20例(32.3%)为HGD,27例(43.5%)为IC。单因素分析显示附壁结节大小和主胰管宽度是预测IPMN病理类型的因素。附壁结节大小每增加1 mm,病理分级增加的风险就增加8%。多因素分析显示,仅附壁结节≥5 mm(OR=7.31,95%CI:2.49~21.40,P<0.001)具有区分LGD、HGD和IC三者的效能。将附壁结节≥5 mm赋2分,主胰管宽度≥10 mm和<5 mm的附壁结节分别赋1分,形成内镜超声评分系统。结果显示,该评分系统区分良恶性IPMN的灵敏度、特异度和受试者特征曲线下面积分别为0.830、0.867和0.867。结论术前内镜超声有助于区分IPMN的病理类型,附壁结节大小和主胰管宽度是区别良恶性IPMN的重要因素。

Objective To explore the preoperative diagnostic value of endoscopic ultrasonography(EUS)for intraductal papillary mucinous neoplasms(IPMN).Methods Data of 62 patients with IPMN confirmed by pathology who underwent EUS before surgery from 2008 to 2018 in Peking Union Medical College Hospital were analyzed.Characteristics that could distinguish low-grade dysplasia(LGD),high-grade dysplasia(HGD)and invasive carcinoma(IC)were explored.A scoring system based on EUS findings was established to determine the preoperative pathology of IPMN by using logistic model.Results Of the 62 patients,15(24.2%)were diagnosed as having LGD,20(32.3%)HGD and 27(43.5%)IC.Univariate analysis showed that the size of mural nodules and width of main pancreatic duct(MPD)were predictive factors for IPMN pathology.The possibility of higher pathological grading would increase 8%for every 1 mm increment in mural nodules.Multivariate analysis showed that only mural nodules≥5 mm(OR=1.31,95%CI:2.49-21.40,P<0.001)was an independent risk factor to distinguish LGD,HGD and IC.Mural nodules≥5 mm,main pancreatic duct(MPD)≥10 mm and mural nodules<5 mm were assigned 2 points,1 point and 1 point,respectively.The sensitivity,specificity,and area under receiver operator characteristic curve(AUC)of the EUS scoring system to distinguish benign and malignant IPMN were 0.830,0.867,and 0.867,respectively.Conclusion Preoperative EUS helps to distinguish LGD,HGD and IC.The size of mural nodules and the width of MPD are vital risk factors to distinguish benign and malignant IPMN.