线阵超声胃镜检查与强化CT、磁共振成像检查对十二指肠乳头癌的诊断效能比较

Diagnostic efficacy of linear array ultrasound gastroscopy versus enhanced CT examination and magnetic resonance imaging for duodenal papillary carcinoma

目的比较线阵超声胃镜(EUS)检查、强化CT检查、磁共振成像(MRI)检查对十二指肠乳头癌的诊断效能。方法选取79例十二指肠乳头占位病变患者作为研究对象,分别行EUS检查和上腹部强化CT、MRI检查。将EUS、CT、MRI检查结果分别与金标准结果(内镜下逆行胰胆管造影、活检组织学检查或手术病理等结果)进行比较,计算EUS检查、强化CT检查、MRI检查对十二指肠乳头癌的诊断效能(灵敏度、特异度、准确度),并进行统计学分析。结果79例十二指肠乳头占位病变中,金标准诊断结果为十二指肠乳头癌71例、十二指肠乳头腺瘤或低级别上皮内瘤变8例,EUS检查诊断结果为十二指肠乳头癌73例(其中金标准结果为十二指肠乳头腺瘤或低级别上皮内瘤变者2例)、十二指肠乳头腺瘤或低级别上皮内瘤变6例,强化CT检查诊断结果为十二指肠乳头癌30例、十二指肠腺瘤或低级别上皮内瘤变等病变49例,MRI检查诊断结果为十二指肠乳头癌38例(金标准结果均为十二指肠乳头癌)、十二指肠乳头腺瘤或低级别上皮内瘤变等病变41例。EUS检查对十二指肠乳头癌的诊断灵敏度为100.00%(71/71),高于强化CT检查的42.25%(30/71)、MRI检查的53.52%(38/71),差异有统计学意义(P<0.01);EUS检查对十二指肠乳头癌的诊断准确度为97.47%(77/79),高于强化CT检查的48.10%(38/79)、MRI检查的58.23%(46/79),差异有统计学意义(P<0.01);EUS检查的诊断特异度与CT检查、MRI检查比较,差异无统计学意义(P>0.05)。结论相较于强化CT检查、MRI检查,EUS检查对十二指肠乳头癌具有更高的诊断效能,表现为灵敏度和准确度均较高。EUS检查能同时获取活检病理标本,故十二指肠乳头占位病变患者可将其作为优先检查手段。

Objective To compare the diagnostic efficacy of linear endoscopic ultrasonography(EUS),enhanced CT examination and magnetic resonance imaging(MRI)for major duodenal papilla carcinoma.Methods Seventy-nine patients with duodenal papilla occupying lesion were selected as study objects,separately undergoing EUS,enhanced CT-scan and MRI of the upper abdomen,the results of EUS,CT and MRI were compared with those of gold standard results(endoscopic retrograde cholangiopancreatography,biopsy histology or surgical pathology,etc.).The diagnostic efficiency(sensitivity,specificity and accuracy)of EUS,enhanced CT and MRI for major duodenal papilla carcinoma were calculated to make statistical comparison.Results Of 79 cases with duodenal papilla occupying lesions,71 patients were diagnosed as duodenal papilla carcinoma by gold standard,8 were diagnosed as duodenum adenoma or low grade intraepithelial neoplasia.EUS diagnosis results showed there were 73 cases of duodenal papillary carcinoma(2 cases of duodenal papillary adenoma or low-grade intraepithelial neoplasia by gold standard)and 6 cases of duodenal papillary adenoma or low-grade intraepithelial neoplasia.A total of 30 cases of duodenal papillary carcinoma and 49 cases of duodenal adenoma or low-grade intraepithelial neoplasia were diagnosed by enhanced CT examination.MRI results showed that there were 38 cases of duodenal papillary carcinoma(their gold standard results were all duodenal papillary carcinoma),41 cases of duodenal papillary adenoma or low-grade intraepithelial neoplasia.The diagnostic sensitivity of EUS for duodenal papillary carcinoma was100.00%(71/71),which was higher than 42.25%(30/71)of enhanced CT and 53.52%(38/71)for MRI(P<0.01).The diagnostic accuracy of EUS for duodenal papillary carcinoma was97.47%(77/79),which was higher than 48.10%(38/79)of enhanced CT and 58.23%(46/79)of MRI(P<0.01).There was no significant difference in diagnostic specificity of US examination compared with CT examination and MRI examination(P>0.05).Conclusion Compared with enhanced CT and MRI,EUS has higher diagnostic efficacy in duodenal papillary carcinoma,and shows higher sensitivity and accuracy.EUS can obtain pathological biopsy specimens at the same time,so it is a preferred mean of examination for patients with duodenal papillary space occupying lesions.