Pancreas sparing duodenectomy in the treatment of primary duodenal neoplasms and other situations with duodenal involvement

Background:There are no clearly defined indications for pancreas-preserving duodenectomy.The present study aimed to analyze postoperative morbidity and the outcomes of patients undergoing pancreaspreserving duodenectomy.Methods:Patients undergoing pancreas-preserving duodenectomy from April 2008 to May 2020 were included.We divided the series according to indication:scenario 1,primary duodenal tumors;scenario 2,tumors of another origin with duodenal involvement;and scenario 3,emergency duodenectomy.Results:We included 35 patients.Total duodenectomy was performed in 1 patient of adenomatous duodenal polyposis,limited duodenectomy in 7,and third+fourth duodenal portion resection in 27.The indications for scenario 1 were gastrointestinal stromal tumor(n=13),adenocarcinoma(n=4),neuroendocrine tumor(n=3),duodenal adenoma(n=1),and adenomatous duodenal polyposis(n=1);scenario 2:retroperitoneal desmoid tumor(n=2),recurrence of liposarcoma(n=2),retroperitoneal paraganglioma(n=1),neuroendocrine tumor in pancreatic uncinate process(n=1),and duodenal infiltration due to metastatic adenopathies of a germinal tumor with digestive hemorrhage(n=1);and scenario 3:aortoenteric fistula(n=3),duodenal trauma(n=1),erosive duodenitis(n=1),and biliopancreatic limb ischemia(n=1).Severe complications(Clavien-Dindo≥IIIb)developed in 14%(5/35),and postoperative mortality was 3%(1/35).Conclusions:Pancreas-preserving duodenectomy is useful in the management of primary duodenal tumors,and is a technical option for some tumors with duodenal infiltration or in emergency interventions.

Perforation associated with endoscopic submucosal dissection for duodenal neoplasm without a papillary portion

AIM To investigate predictors of perforation after endoscopic resection(ER) for duodenal neoplasms without a papillary portion.METHODS This was a single-center, retrospective, cohort study conducted between April 2003 and September 2014. A total of 54 patients(59 lesions) underwent endoscopic mucosal resection(EMR)(n = 36) and endoscopic submucosal dissection(ESD)(n = 23). Clinical features, outcomes, and predictors of perforation were investigated.RESULTS Cases of perforation occurred in eight(13%) patients(95%CI: 4.7%-22.6%). Three ESD cases required sur-gical management because they could not be repaired by clipping. Delayed perforation occurred in two ESD cases, which required surgical management, although both patients underwent prophylactic clipping. All patients with perforation who required surgery had no postoperative complications and were discharged at anaverage of 13.2 d after ER. Perforation after ER showed a significant association with a tumor size greater than20 mm(P = 0.014) and ESD(P = 0.047).CONCLUSION ESD for duodenal neoplasms exceeding 20 mm may be associated with perforation. ESD alone is not recom-mended for tumor treatment, and LECS should be con-sidered as an alternative.

Endoscopic Mucosal Resection of Mucosal Neoplasm Located on the Duodenal Bulb through Endoscope Retroflexion

OBJECTIVE To assess the results of endoscopic mucosal resection （EMR） of benign mucosal neoplasms located on the duodenal bulb using endoscope retroflexion. METHODS This study involved 14 patients with 16 mucosal neoplasms located on the duodenal bulb. The diameter of each neoplasm was less than 15 mm. After endoscope retroflexion within the duodenum for evaluation of the size, extent and depth of the tumor, EMR was attempted with endoscope retroflexion for removing the lesion in the duodenal bulb. The rate of endoscope retroflexion, the time required for endoscope retroflexion, median operation time, curative resection rate, en bloc resection rate, complication, and median follow-up period were evaluated. RESULTS Sixteen lesions in 14 patents （median age of 56 years, 5 female, 9 male） were removed through EMR. The mean size of the lesions resected was 6.9 mm （median size of 5.5 mm, range of 3-15 mm）. Post-EMR histologic examination revealed Brunner＇s gland hyperplasia in 6, gastric mucosal metaplasia in 5, adenoma in 1, chronic inflammation in 3, and benign lymphocytic hyperplasia in 1. The curative resection rate was 100% （16/16）, and the en bloc resection rate was 94% （15/16）, with EMR. One of the lesions was piecemeal removed through EMR for its large size （15 mm） and for its involving the area from the duodenal bulb to the pyloric ring. The success rate of endoscope retroflexion within the duodenum was 94% （15/16）. The time required for endoscope retroflexion was longer for the first 10 lesions （median time of 2 min, range of 1-2.5 min） than that for the last 5 lesions （median time of 1.5 min, range of 1-2 min）. The median follow-up period was 22 months （range of 4-48 months）. During the follow-up, no residual, no pyloric or duodenal stenosis was found in any of the patients after EMR. There was no severe hemorrhage, or perforations occurring. CONCLUSION EMR of mucosal neoplasm located on the duodenal bulb through endoscope retroflexion, which is a feasible and useful adjunctive procedure, appears to be a safe and effective technique.

Treatment for superficial non-ampullary duodenal epithelial tumors

Because of the low prevalence of non-ampullary duodenal epithelial tumors(NADETs),standardized clinical management of sporadic superficial NADETs,including diagnosis,treatment,and follow-up,has not yet been established.Retrospective studies have revealed certain endoscopic findings suggestive of malignancy.Duodenal adenoma with high-grade dysplasia and mucosal cancer are candidates for local resection by endoscopic or minimally invasive surgery.The use of endoscopic treatment including endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD),for the treatment for superficial NADETs is increasing.EMR requires multiple sessions to achieve complete remission and repetitive endoscopy is needed after resection.ESD provides an excellent complete resection rate,however it remains a challenging method,considering the high risk of intraoperative or delayed perforation.Minimally invasive surgery such as wedge resection and pancreas-sparing duodenectomy are beneficial for superficial NADETs that are technically difficult to remove by endoscopic treatment.Pancreaticoduodenectomy remains a standard surgical procedure for treatment of duodenal cancer with submucosal invasion,which presents a risk of lymph node metastasis.Endoscopic or surgical treatment outcomes of superficial NADETs without submucosal invasion are satisfactory.Establishing an endoscopic diagnostic tool to differentiate superficial NADETs between adenoma and cancer as well as between mucosal and submucosal cancer is required to select the most appropriate treatment.

Endoscopic and biopsy diagnoses of superficial, nonampullary, duodenal adenocarcinomas

AIM: To investigate the accuracy of endoscopic or biopsy diagnoses of superficial nonampullary duodenal epithelial tumors(NADETs).METHODS:Clinicopathological data were reviewed for84 superficial NADETs from 74 patients who underwent surgery or endoscopic resection between September2002 and August 2014 at a single prefectural cancer center.Superficial NADETs were defined as lesions confined to the mucosa or submucosa.Demographic and clinicopathological data were retrieved from charts,endoscopic and pathologic reports.Endoscopic reports included endoscopic diagnosis,location,gross type,diameter,color,and presence or absence of biopsy.Endoscopic diagnoses were made by an endoscopist in charge of the examination before biopsy specimens were obtained.Endoscopic images were obtained using routine,front-view,high-resolution video endoscopy,and chromoendoscopy with indigocarmine was performed for all lesions.Endoscopic images were reviewed by at least two endoscopists to assess endoscopic findings indicative of carcinoma.Preoperative diagnoses based on endoscopy and biopsy findings were compared with histological diagnoses of resected specimens.Sensitivity,specificity,and accuracy were assessed for endoscopic diagnosis and biopsy diagnosis.RESULTS:The majority(81%)of the lesions were located in the second portion of the duodenum.The median lesion diameter was 14.5 mm according to final histology.Surgery was performed for 49 lesions from 39 patients,and 35 lesions from 35 patients were endoscopically resected.Final histology confirmed 65carcinomas,15 adenomas,and 3 hyperplasias.A finaldiagnosis of duodenal carcinoma was made for 91%(52/57)of the lesions diagnosed as carcinoma by endoscopy and 93%(42/45)of the lesions diagnosed as carcinoma by biopsy.The sensitivity,specificity,and accuracy of endoscopic diagnoses were 80%,72%,and 78%,respectively,whereas those of biopsy diagnoses were 72%,80%,and 74%,respectively.Preoperative diagnoses of carcinomas were made in88%(57/65)of the carcinoma lesions via endoscopy or biopsy.Endoscopic findings associated with carcinoma were red color,depression,and mixed-type morphology.CONCLUSION:Preoperative endoscopy and biopsy showed similar accuracies in the diagnosis of carcinoma in patients with superficial NADETs.

Hepatopancreatoduodenectomy for metastatic duodenal gastrointestinal stromal tumor

BACKGROUND: Duodenal gastrointestinal stromal tumors, which are rare, comprise 3%-5% of all gastrointestinal stromai tumors. We present a case of a metastatic duodenal gastrointestinal stromal tumor that was successfully treated by simultaneous tight hemihepatectomy and pancreaticoduodenectomy. METHODS: A 50-year-old woman was admitted to our department for the treatment of a possible metastatic duodenal gastrointestinal stromal tumor (GIST). At laparotomy a large duodenal tumor was found displacing the head of the pancreas. A 3 cm in diameter lesion in the posterior aspect of segment Ⅷ of the liver was also noted. Simultaneous right hepatectomy and pancreaticoduodenectomy were performed. RESULTS: Histological examination revealed a high grade metastatic duodenal GIST strongly positive for c-kit, CD34, and vimentin. The patient had no additional therapy. A follow-up of 21 months showed that the patient is very well and there is no evidence of recurrent diseases. CONCLUSIONS: Malignant stromai tumors of the duodenum are rarely encountered. They are usually slow growing, and may be amenable to curative surgery, even after occurrence of metastases. Resection of localized liver metastasis is still advocated when feasible, since imatinib does not provide a complete or long-term response. Combined surgical resection is an efficacious treatment for patients with metastatic duodenal gastrointestinal stromal tumor.

Endoscopic mucosal resection with circumferential mucosal incision of duodenal carcinoid tumors

Duodenal carcinoids are a rare form of neuroendocrine tumors, and tend to invade the submucosa during the early stage. Endoscopic treatment is generally recommended for duodenal carcinoids less than 10 mm in diameter. Although a few reports have described the use of endoscopic resection of duodenal carcinoids, there are no published studies on endoscopic mucosal resection with circumferential mucosal incision (EMR-CMI). We performed EMR-CMI for 5 cases of duodenal carcinoids in the duodenal bulb. The mean tumor diameter was 4.6 ± 1.8 mm. Although all of the tumors were located in the submucosa, R0 resection was performed without complication in each case. EMR-CMI may thus be a safe and effective treatment for duodenal carcinoids less than 10 mm in diameter.

Review of lymphoma in the duodenum: An update of diagnosis and management

The presentation,subtype,and macroscopic images of lymphoma vary depending on the site of the tumor within the gastrointestinal tract.We searched PubMed for publications between January 1,2012 and October 10,2022,and retrieved 130 articles relating to duodenal lymphoma.A further 22 articles were added based on the manual screening of relevant articles,yielding 152 articles for full-text review.The most predominant primary duodenal lymphoma was follicular lymphoma.In this review,we provide an update of the diagnosis and management of representative lymphoma subtypes occurring in the duodenum:Follicular lymphoma,diffuse large B-cell lymphoma,extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue,mantle cell lymphoma,and Tcell lymphomas.

Preoperative endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors, including magnifying endoscopy

Superficial non-ampullary duodenal epithelial tumor(SNADET) is defined as a sporadic tumor that is confined to the mucosa or submucosa that does not arise from Vater's papilla, and it includes adenoma a n d a d e n o c a r c i n o m a. R e c e n t d e v e l o p m e n t s i n endoscopic technology, such as high-resolution endoscopy and image-enhanced endoscopy, may increase the chances of detecting SNADET lesions. However, because SNADET is rare, little is known about its preoperative endoscopic diagnosis. The use of endoscopic resection for SNADET, which has no risk of metastasis, is increasing, but the incidence of complications, such as perforation, is significantly higher than in any other part of the digestive tract. A preoperative diagnosis is required to distinguish between lesions that should be followed up and those that require treatment. Retrospective studies have revealed certain endoscopic findings that suggest malignancy. In recent years, several new imaging modalities have been developed and explored for realtime diagnosis of these lesion types. Establishing an endoscopic diagnostic tool to differentiate between adenoma and adenocarcinoma in SNADET lesions is required to select the most appropriate treatment. This review describes the current state of knowledge about preoperative endoscopic diagnosis of SNADETs, such as duodenal adenoma and duodenal adenocarcinoma. Newer endoscopic techniques, including magnifying endoscopy, may help to guide these diagnostics, but their additional advantages remain unclear, and further studies are required to clarify these issues.

Spontaneous expulsion of a duodenal lipoma after endoscopic biopsy: A case report

BACKGROUND Gastrointestinal(GI)lipomas are benign submucosal tumors of mature adipocytes that arise mainly in the colon and stomach,sometimes in the ileum and jejunum,and rarely in the duodenum.Patients with symptomatic lipomas require endoscopic or surgical treatment.Spontaneous expulsion of lipomas after biopsy is a rare condition that has limited case reports.CASE SUMMARY A 56-year-old man presented to our hospital with intermittent postprandial epigastric fullness.Esophagogastroduodenoscopy(EGD)revealed a 10-mm soft yellowish submucosal lesion with the“pillow sign,”located in the second portion of duodenum.Endoscopic ultrasonography(EUS)using a 12-MHz catheter probe showed a hyperechoic,homogenous,and round solid lesion(OLYMPUS EUS EUME2,UM-DP12-25R,12-MHz radial miniprobe,Olympus Corporation,Tokyo,Japan).Deep biopsy was performed using the bite-on-bite technique with forceps.Histological examination was compatible with submucosal lipoma.The lesion spontaneously expelled 12 d after the biopsy.Follow-up EUS performed after 2 mo confirmed this condition.CONCLUSION Deep biopsy could lead to spontaneous GI lipoma expulsion.This might be the first step in lipoma diagnosis and treatment.

Duodenal ulcer caused by coil wiggle after digital subtraction angiography-guided embolization: A case report

BACKGROUND Acute gastrointestinal bleeding(GIB)is a life-threatening medical emergency with high morbidity and mortality.Transcatheter embolization with endovascular coils under digital subtraction angiography guidance is a common and effective method for the treatment of GIB with high technical success rates.Duodenal ulcers caused by coils wiggled from the branch of the gastroduodenal artery,which is a rare complication,have not previously been reported in a patient with right intrathoracic stomach.CASE SUMMARY A 62-year-old man had undergone thoracoscopy-assisted radical resection of esophageal cancer and gastroesophageal anastomosis 3 years ago,resulting in right intrathoracic stomach.He was admitted to the hospital 15 mo ago for dizziness and suffered acute GIB during his stay.Interventional surgery was urgently performed to embolize the branch of the gastroduodenal artery with endovascular coils.After 15 mo,the patient was re-admitted with a chief complaint of melena for 2 d,esophagogastroduodenoscopy and abdominal computed tomography revealed that some endovascular coils had migrated into the duodenal bulb,leading to a deep ulcer.Bleeding was controlled after conservative treatment.Seven months later,duodenal balloon dilatation was performed to relieve the stenosis after the removal of a few coils,and the patient was safely discharged with only one coil retained in the duodenum due to difficulties in complete removal and risk of bleeding.Mild melena recurred once during the long-term follow-up.CONCLUSION Although rare,coil wiggle after interventional therapy requires careful attention,effective precautionary measures,and more secure alternative treatment methods.

MRI与X线联合评估乳腺非肿块样病变恶性风险的Logistic回归模型建立及应用评价

目的:基于MRI与X线特征建立乳腺非肿块样病变(Non-mass-like lesions,NML)恶性风险的预测模型,期望提高诊断准确率,为临床决策提供依据。方法:对我院2021年7月-2023年4月符合纳入标准的150例患者的资料进行回顾性分析,使用Logistic回归构建NML恶性风险预测模型及列线图,采用校准曲线评估模型准确度,用受试者工作特征(ROC)曲线评估模型的诊断效能。结果:多因素分析显示簇状环形强化、时间-信号强度曲线(TIC)类型、ADC值、线样及段样分布钙化等影像特征是预测病变恶性风险的因素。基于MRI特征的模型的ROC曲线下面积为0.941,灵敏度为88.7%,特异度为86.6%。基于MRI联合X线特征的模型的ROC曲线下面积为0.951,灵敏度为91.5%,特异度为91.4%,校准曲线预测准确度较好。结论 :基于MRI联合X线特征建立的乳腺NML恶性风险Logistic回归模型诊断效能较高,具有一定的应用潜力。

1例十二指肠癌肉瘤CT及MRI表现

患者男,68岁,便血20余天;10余年前患上消化道出血,经保守治疗后好转;无家族遗传病史。查体未见明显异常。实验室检查:糖类抗原12537.76U/ml,游离/总前列腺特异性抗原7.61%;肌酸激酶31U/ml,脂蛋白a 95mg/dl。胃镜:十二指肠乳头部明显增生,开口处黏膜增生,表面糜烂。

基于深度学习的曲面体层片颌骨病变辅助诊断技术研究

目的 探讨深度学习应用于曲面体层片辅助诊断颌骨透射病变、颌骨阻射病变的效果,以减少漏诊,辅助医生早期筛查、提高诊断准确性。方法 本研究通过四川大学华西口腔医院伦理委员会批准。以443例曲面体层片为研究对象,构建YOLO v8m-p2神经网络模型,将标注后的图像分为训练集354例,验证集45例和测试集44例,用于模型训练、验证和测试。采用精确率、召回率、F-1分值、G分值、mAP50评价模型的检测性能。结果 443例曲面体层片涵盖颌骨常见的良性病变,其中颌骨透射病变数量为318,包括含牙囊肿、牙源性角化囊肿、成釉细胞瘤3类病变;颌骨阻射病变数量为145,包含特发性骨硬化、牙瘤、牙骨质瘤、牙骨质-骨结构不良4类病变,样本有良好的代表性。YOLO v8m-p2神经网络模型识别颌骨病变的性能:精确率为0.887,召回率为0.860,F-1分值为0.873,G分值为0.873,mAP50为0.863。其中,含牙囊肿、牙源性角化囊肿、成釉细胞瘤召回率分别为0.833、0.941、0.875。结论 YOLO v8m-p2神经网络模型应用于初步检测口腔曲面体层片中的颌骨透射病变及颌骨阻射病变以及多分类检测颌骨透射病变时诊断性能表现良好,可辅助医生筛查曲面体层片的颌骨疾病。

Malignant gangliocytic paraganglioma of the duodenum with distant metastases and a lethal course

Gangliocytic paraganglioma (GP) is rare and has been regarded as benign in general with a good prognosis. We present a patient with duodenal GP showing a malignant and lethal clinical course. A 47-year-old male patient was found to have a duodenal tumor and enlarged regional lymph nodes. The patient initially underwent a pancreaticoduodenectomy to resect the tumor and involved lymph nodes completely. Histological and immunohistochemical analyses showed findings typical of GP. However, the distant metastatic lesions in the liver and pelvic cavity were rapidly observed after surgery. The patient underwent chemotherapy and radiotherapy, as well as a second surgery to partly remove the metastatic mass in the pelvic cavity. The histological examination revealed no significant difference in histological features between the primary duodenal tumor and the metastatic pelvic mass. However, the patient finally died of the tumor due to the recurrence of the residual pelvic lesion and increased liver mass. To our knowledge, this is the first report of lethal GP with multifocal metastases. Our case confirms that GP should be regarded as a malignant potential tumor with behavior code of “1”, rather than a benign tumor of “0”.

Segmental duodenectomy for gastrointestinal stromal tumor of the duodenum

AIM: To evaluate the results of segmental duodenectomy (SD) and pancreaticoduodenectomy (PD) for duodenal gastrointestinal stromal tumor (GIST) and help clinicians with surgical management. METHODS: All patients who underwent surgery for non-metastatic GIST of the duodenum in a single institution since 2000 were prospectively followed up. Seven patients (median age 51 years, range: 41-73 years) were enrolled: five underwent SD and two underwent PD. RESULTS: All the patients had a complete resection (R0), with no postoperative morbidity and mortality. Among the SD group, GIST was classified as low risk in two patients, intermediate risk in two, and high risk in one, according to the Fletcher scale, (vs two high risk patients in the PD group). With a median followup of 41 (18-85) mo, disease-free survival (DFS) rateswere 100% after SD and 0% after PD (P < 0.05). The median DFS was 13 mo in the PD group. CONCLUSION: Whenever associated with clear surgical margins, SD is a reliable and curative option for most duodenal GISTs, and is compatible with longterm DFS.

Pancreas-preserving segmental duodenectomy for gastrointestinal stromal tumor of the duodenum and splenectomy for splenic angiosarcoma

BACKGROUND: Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract and occur rarely in the duodenum. Splenic angiosarcoma is an aggressive neoplasm with an extremely poor prognosis. METHODS: We report a case of a 70-year-old man hospitalized for abdominal pain in the upper quadrants, dyspepsia and nausea, previously treated for Hodgkin lymphoma 30 years ago. Abdominal CT showed a solid nodular lesion in the third portion of the duodenum, the presence of retropancreatic, aortic and caval lymph nodes, and four nodular splenic masses. 111 In-octreotide scintigraphy revealed pathological tissue accumulation in the duodenal region, and in the retropancreatic, retroduodenal, aortic and caval lymph nodes, suggesting a nonfunctioning neuroendocrine peripancreatic tumor. RESULTS: At exploratory laparotomy, an exophytic soft tumor was found originating from the third portion of the duodenum. Pancreas-preserving duodenectomy with duodenojejunostomy, splenectomy and lymphnodectomy of retropancreatic aortic and caval lymph nodes were performed. Pathological evaluation and immunohistochemical studies showed the presence of a duodenal gastrointestinal stromal tumor with low mitotic activity and a well-differentiated angiosarcoma localized to the spleen and invading lymph nodes.CONCLUSIONS: We speculated that the angiosarcoma and duodenal gastrointestinal stromal tumors of this patient were due to the treatment of Hodgkin lymphoma with radiotherapy 30 years ago. Pancreas-preserving segmental duodenectomy can be used to treat non-malignant neoplasms of the duodenum and avoid extensive surgery. Splenectomy is the treatment of choice for localized angiosarcomas but a strict follow-up is mandatory because of the possibility of recurrence.

Two synchronous somatostatinomas of the duodenum and pancreatic head in one patient

Somatostatinomas are extremely rare neuroendocrine tumors of the gastrointestinal tract,f irst described in the pancreas in 1977 and in the duodenum in 1979.They may be functional and cause somatostatinoma or inhibi-tory syndrome,but more frequently are non-functioning pancreatic endocrine tumors that produce somatostatin alone.They are usually single,malignant,large lesions,frequently associated with metastases,and generally with poor prognosis.We present the unique case of a 57-year-old woman with two synchronous non-function-ing somatostatinomas,one solid duodenal lesion and one cystic lesion within the head of the pancreas,that were successfully resected with a pylorus-preserving Whipple's procedure.No secondaries were found in the liver,or in any of the removed regional lymph nodes.The patient had an uneventful recovery,and remains well and symptom-free at 18 mo postoperatively.This is an extremely rare case of a patient with two synchro-nous somatostatinomas of the duodenum and the pancreas.The condition is discussed with reference to the literature.

基于术前超声及钼靶特征的列线图预测乳腺癌腋窝淋巴结转移的价值

目的:探讨术前超声、钼靶特征及病理因素对乳腺癌腋窝淋巴结转移(ALNM)的预测价值并构建列线图预测模型。方法:回顾性分析282例乳腺癌患者的原发灶和腋窝淋巴结的超声、钼靶特征及病理资料,以7∶3的比例将其随机分为训练集(n=197)及测试集(n=85),对比两组的一般资料,训练集中通过Lasso回归和Logistic回归分析确定ALNM的独立影响因素并构建列线图模型,用测试集数据验证模型,分别采用受试者工作特征(ROC)曲线下面积(AUC)和一致性指数(C-index)、校准曲线、临床决策曲线评价模型的区分度、校准度及临床适用性。结果:训练集和测试集之间除皮质增厚外,其他因素间差异均无统计学意义(均P>0.05)。Lasso回归结合Logistic回归分析结果显示超声特征(外上象限、肿瘤最大径>2 cm、超声提示ALNM)、钼靶特征(肿块边缘毛刺、钼靶提示ALNM)、Ki-67≥20%是乳腺癌ALNM的独立影响因素(OR=2.234、2.672、4.752、5.995、5.252、3.708,均P<0.05),以此构建预测乳腺癌ALNM的列线图模型,训练集中列线图模型的AUC为0.858(95%CI:0.804~0.912),C-index为0.858,测试集中列线图模型的AUC为0.863(95%CI:0.771~0.954),C-index为0.863,列线图模型有良好的区分度。校准曲线和临床决策曲线提示列线图有良好的校准度和临床适用性。结论:基于乳腺癌原发灶和腋窝淋巴结的术前超声、钼靶特征及病理因素构建的列线图可为无创预测乳腺癌ALNM提供有价值的信息,协助临床医生制定个性化诊疗方案。

内镜下十二指肠乳头切除术后短期不良事件危险因素的初步探索

目的本研究旨在探索与内镜下十二指肠乳头切除术(endoscopic papillectomy,EP)术后短期不良事件相关的危险因素。方法本研究纳入接受EP的十二指肠乳头肿瘤(duodenal papilla neoplasms,DPNs)患者,收集其一般情况资料、实验室检查指标、手术相关情况以及病理情况,通过独立样本t检验、Mann-Whitney U检验以及χ^(2)检验分别对上述指标进行初步统计学分析,筛选与术后不良事件相关的临床因素。结果78例接受EP的DPNs患者中,共有43例患者出现了4种不良事件,包括14例(17.9%)术后胰腺炎(acute pancreatis,AP),7例(9.0%)术后出血,14例(17.9%)高淀粉酶血症以及10例(12.8%)非特异性腹痛。患者糖尿病史以及身高情况可能是术后不良事件的相关因素,术前丙氨酸氨基转移酶(alanine aminotransferase,ALT)水平以及术后即刻炎症指标的升高有助于早期识别术后AP及出血的发生。内镜下黏膜切除术(endoscopic mucosal resection,EMR)有助于降低术后AP的发生,而病变整块切除有利于术后出血的预防。病变大小与恶性程度同样影响术后不良事件的发生情况。结论EP时预防性支架放置以及黏膜下注射并不能改善术后情况,而内镜切除方式与整块切除情况等指标对EP术后不良事件的发生存在影响。