谐波造影增强超声内镜技术在诊断胰腺实性肿物的作用

The role of Contrast-Enhanced Harmonic Endoscopic Ultrasonography in the diagnosis of pancreatic solid lesion

目的评价谐波造影增强超声内镜技术对胰腺实性肿物性质诊断的临床价值。方法回顾性选取2018年1月至2021年9月影像学发现胰腺实性肿物,在中山大学肿瘤防治中心行超声内镜及谐波造影增强超声内镜检查的患者134例,比较超声内镜和谐波造影增强超声内镜对胰腺实性肿物诊断与病理学诊断的符合率。结果入组的患者中,胰腺恶性病变有113例,良性病变21例。超声内镜对胰腺实性肿物诊断的敏感度、特异度、诊断的符合率分别为61.9%、52.4%和60.4%;谐波造影增强超声内镜对胰腺实性肿物诊断的敏感性、特异性、诊断的符合率分别为84.1%、80.9%和83.6%,差异有统计学意义(P=0.017)。病理诊断为恶性肿瘤的113例病例中,超声内镜诊断为胰腺腺癌65例,诊断胰腺癌的灵敏度、特异度、诊断符合率分别为65.0%、46.2%和62.8%;谐波造影增强超声内镜诊断为胰腺腺癌88例,诊断胰腺癌的灵敏度、特异度、诊断符合率分别为88.0%、84.6%和87.6%,高于超声内镜检查,差异有统计学意义(P<0.001)。结论谐波造影增强超声内镜技术有助于胰腺肿物良恶性性质的判断,对区分胰腺癌和胰腺其他恶性肿瘤中有较高的临床价值。

Objective To evaluate the clinical value of contrast-enhanced harmonic endoscopic ultrasonography(CH-EUS)in the diagnosis of the properties of pancreatic solid lesion.Methods From January 2018 to September 2021,134 patients with pancreatic solid lesion found in imaging were retrospectively analyzed in the study.The patients who underwent Endoscopic ultrasound(EUS)and CH-EUS,who were diagnosed as periampullary lesions by surgery or Endoscopic ultrasound-fine-needle aspiration in our hospital.The consistency rate of EUS and CH-EUS for the diagnosis of pancreatic solid lesion and pathological diagnosis was compared.Results There were 113 cases of malignant pancreatic lesions and 21 cases of benign lesions Among the patients enrolled.The sensitivity,specificity and the diagnostic accuracy of EUS for pancreatic solid lesion were 61.9%,52.4%and 60.4%,respectively,and the sensitivity,specificity and diagnostic accuracy rate of CH-EUS for pancreatic solid lesion were 84.1%,80.9%and 83.6%,respectively.The difference was statistically significant(P=0.017).Among the 113 cases of pathological diagnosis of malignant tumors,65 cases were diagnosed with pancreatic adenocarcinoma by EUS,and the sensitivity,specificity,and diagnostic accuracy rates of EUS in the diagnosis of pancreatic cancer were:65.0%,46.2%and 62.8%;respectively;88 cases were diagnosed as pancreatic adenocarcinoma by CH-EUS,and the sensitivity,specificity,and diagnostic accuracy rates of CH-EUS were:88.0%,84.6%and 87.6%,respectively.The difference was statistically significant(P<0.001).Conclusion CH-EUS is helpful for judging the benign and malignant properties of Pancreatic solid lesion.It has high clinical value in distinguishing pancreatic cancer from other malignant tumors of the pancreas.